B. Financial Information
List the three references indicated below based on your largest provider/customer:
EntityContactPhone
Bank:
Current customer:
Current Vendor:
Has your company ever filed for bankruptcy? |
Yes___ No____ |
If yes, indicate date and |
|
explanation____________________________________________________________________________
______________________________________________________________________________________
_____________________________________________________________________________________
Is your company involved in any ongoing or pending litigation?Yes___ No____
If yes, please provide the name of the cause of action, the court in which the cause of action is being heard, and the nature of the litigation______________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Indicate the name of your legal firm or contact within your company:
______________________________________________________________________________________
Credit and Reference Disclosure Authorization
I understand that in connection with my application for qualification as vendor for Cracker Barrel Old Country Store, Inc., its divisions, affiliates, or related companies, a full verification of credit/financial and business reference may be performed. I hereby consent and authorize Cracker Barrel Old Country Store, Inc., its divisions, affiliates, related companies, or its authorized agent to examine or receive a copy of any and/or all records maintained by any Bank, Credit Agency, or Financial Institution to the same extent as if I personally applied for the same. I hereby authorize such records to be disclosed or furnished in accordance with any request made by the bearer in connection with either my application or any subsequent contractual relationship established pursuant to such application.
I agree to hold harmless anyone who provides or submits information to the bearer, pursuant to this authorization.
Company Name_____________________________________ Date_______________________________
Certified By (Signature)______________________________Print_______________________________
Title__________________________________________________________________________________