LapTraveler.com reseller Bank Reference

IF YOU WOULD LIKE TO RESELL OUR PRODUCTS, PLEASE BEGIN WITH RESELLER INFORMATION

1. Print this form.
2. Fill in your company name and bank account number where indicated.
3. Make sure to sign where indicated.
4. Fax to the appropriate party at your financial institution.

TO BE COMPLETED BY CUSTOMER:

Company Name: _________________________________

Account Number:_________________________________

Authorized To Release Information By: ___________________________________

TO BE COMPLETED BY FINANCIAL INSTITUTION:

Your above listed customer would like to become a distributor for us, and have listed you as a reference.
Please provide the information requested below, and fax back to us at 423-775-0611.
Thank you for taking the time to help your customer and us.

1). How long have you done business with them? ______________________

2). What is their high account balance with your bank? __________________

3). What is their current account balance? ____________________________

4). Have they had any of their company checks returned due to NSF? _______

5). If yes, how much was it for? ____________________________________

6). Do they have more than one account with your bank? ___ How many? ____