EIB 99-14 EXIM Trade Reference Form

OMB 3048-0042
2022 PENDING

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EXIM TRADE REFERENCE FORM

Note: This Trade Reference Form should be completed, signed, and dated by the person obtaining the information. It
should not be completed by any individual closely associated with the foreign buyer, including any shareholders,
employees or related companies of the foreign buyer.
Foreign buyer name & address

Name and address of company giving reference:
Name of person giving reference:
Title:

Phone:

Fax:

Email:

Years of experience with buyer:
Estimated annual sales to buyer (specify currency):
Payment Terms:

Credit limit (specify currency):

Highest amount owed at one time that was paid in past 12 months (specify currency):
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 (specify currency):
Past due balance, if any (specify currency):

Number of days past due:

Payment Experience:
Prompt:

1-30 days slow:

31-60 days slow:

61-90 days slow:

91+ days slow:

Comments:
Name of company taking reference:
Name of person taking reference:
Signature of person taking reference:
Title:

Phone:

Fax:

Email:

Date:
EIB 99-14 (Rev. 12/2018)

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EXIM TRADE REFERENCE FORM

OMB 3048-0042
2022 PENDING

EXIM and its officers and employees are subject to the Trade Secrets Act (18 U.S.C. Sec. 1905) which requires EXIM to
protect confidential Business and commercial information from disclosure, and 12 CFR 404.7 which provides that EXIM
will not disclose information provided in confidence without the submitter's consent and except as required by law. EXIM
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.

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 EXIM being unable to determine eligibility for support. EXIM 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).

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 EXIM
and the Office of Management and Budget, Paperwork Reduction Project OMB # 3048-0042; Washington, D.C. 20503.

EIB 99-14 (Rev. 12/2018)

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