Anglo Irish Bank

INDICATIVE OFFER REQUEST FORM


Kindly provide us with the information requested below, to enable us to indicate on the possibility of without recourse financing for your export receivables:

Importer's country :

Currency & Amount :

*Importer :

*Guarantor Bank :

Credit period requested :

Contract signed :		Yes No

Repayable :		Quarterly Semi-annually Annually Bullet

Goods :

*1st Shipment date :		(yyyy-mm-dd)

*2nd Shipment date :		(yyyy-mm-dd)

*3rd Shipment date :		(yyyy-mm-dd)

*Additional information :



For and on behalf of -

Name of company :

Address :

*By (name) :

*Tel no :

Fax no :

*email :

Date :		(yyyy-mm-dd)



Alternatively you can print this form and fax it to us at the following number: +353 1 6611980