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BANK REFERENCE REQUEST
Dear Customer:
To request a bank reference, please complete and sign Part I, and provide it to your current financial
institution. If for any reason your current institution cannot provide average balance information, you may
attach copies of the last three months of bank statements for this account to the bank reference. Please
contact your Account Opening Specialist or call CitiPhone Banking® at (740) 834-1369 if you need further
assistance.
PART I CUSTOMER AUTHORIZATION
I hereby request a bank reference letter on your bank’s letterhead including the financial information
described below to be provided to Citibank. You may use the template provided in Part II below or your
own standard template for these types of requests. Please note that a representative from Citibank may
call you to confirm this reference so it is important that you include valid contact information.
Please send the reference to me at: <Client Address Line 1>
< Client Address line 2>
You may contact me at the numbers below if you require further information about this request.
_____________________________________ _________________________________________
Client Name Contact phone number/email
X____________________ ____ __________________
Client Signature Date
____________________________________
Name of Bank
_____________________________________
Account Number
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