Bank Reference "*" indicates required fields The undersigned hereby authorizes the following information to be released to Gene Lilly Surety Bonds:Today's Date* MM slash DD slash YYYY By*Re:*To:*To:*Address of Bank* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code We have written or been asked to consider writing bonds for the above and your bank has been given as a reference. Please provide the following information:1. How long has the above been with your bank?*2. Approximate average cash balance last six (6) months:*Have there been over drafts?*Floats?*Returned Checks?*3. General credit experience:*What security was pledged?*4. Is there an established line of credit?*YesNoExpiration Date* MM slash DD slash YYYY What is the gross amount overall?*How much is currently in use?*How is the line secured?*5. Are all loans current?*6. Have any loans been restructured to avoid delinquincy?*7. Additional Comments*Prepared by:* First Last Title*Today's Date* MM slash DD slash YYYY Phone*Email* PhoneThis field is for validation purposes and should be left unchanged.
