Form EIB 99-14 EIB 99-14 Trade Reference form

EX-IM Bank TRADE REFERENCE FORM

Print Form

OMB 3048 - XXXX
Expiry Date:

Note: Trade Experience Form should be signed and dated by the person taking the information.
FOREIGN BUYER NAME & ADDRESS

NAME OF COMPANY GIVING REFERENCE:
NAME OF PERSON GIVING REFERENCE:
TITLE:

PHONE:

FAX:

EMAIL:

YEARS OF EXPERIENCE WITH BUYER:
ESTIMATED ANNUAL SALES TO BUYER:
TERMS OF SALE:
CREDIT LIMIT:

HIGHEST CREDIT OUTSTANDING AND REPAID WITHIN THE PAST 12 MONTHS:

Please describe security, if any, such as a standby letter of credit, personal guarantee or collateral.
If there is no security, so state.

DATE OF LAST SALE:
CURRENT OUTSTANDING BALANCE:
BALANCE PAST DUE:
PAYMENT EXPERIENCE:
Prompt:

30 days slow:

60 days slow:

90+days slow:

COMMENTS:
NAME OF COMPANY TAKING REFERENCE:
NAME OF PERSON TAKING REFERENCE:
SIGNATURE OF PERSON TAKING REFERENCE:
TITLE:

PHONE:

FAX:

E-MAIL:

DATE:

Page 1 of 2

EIB99-14
01/12

EIB99-14 (01/12)

OMB 3048 - XXXX
Expiry Date:

EX-IM Bank TRADE REFERENCE FORM
Note: Trade Experience Form should be signed and dated by the person taking the information.
NOTICES
The applicant is hereby notified that information requested by this form is done so under authority
of the Export-Import Bank Act of 1945, as amended (12 USC 635 et. seq.); provision of this
information is mandatory and failure to provide the requested information may result in Ex-Im
Bank being unable to determine eligibility for support. Ex-Im Bank may not require the
information and applicants are not required to provide information requested in this application
unless a currently valid OMB control number is displayed on this form (see upper right of each
page).
Ex-Im Bank and its officers and employees are subject to the Trade Secrets Act (18 U.S.C. Sec.
1905) which requires Ex-Im Bank to protect confidential Business and commercial information
from disclosure, and 12 CFR 404.7 which provides that Ex-Im Bank will not disclose information
provided in confidence without the submitter's consent and except as required by law. Ex-Im Bank
will endeavor to restrict the disclosure of all information provided in this form to the fullest extent
permissible under federal information disclosure laws including the Freedom of Information Act (5
U.S.C. 552), the Privacy Act of 1974 (5 U.S.C. 552a), or under any other law or court order.
Paperwork Reduction Act Statement
We estimate that it will take you about 15 minutes to complete this form. This includes the time it
will take to read the instructions, gather the necessary facts and fill out the form. However, you are
not required to provide information requested unless a valid OMB control number is displayed on
the form. If you have comments or suggestions regarding the above estimate or ways to simplify
this form, forward correspondence to Ex-Im Bank and the Office of Management and Budget,
Paperwork Reduction Project OMB # 3048-xxxx; Washington, D.C. 20503.

EIB99-14 (01/12)