CBC

CBC
CLEARING BANK

FOR INDEPENDENT RECIPROCAL BARTER EXCHANGE AND CORPORATE BARTER FINANCE COMPANIES

Company Register

ADDRESS INFORMATION

Company Name:
Trade Name:
Principals and officers:

Comercial Register:

Business Street Address 1:
Business Street Address 2:

Country/State:
Province or Region:
Postal Zip Code:
Location/City:

Business Phone:
Business Fax:
Business eMail:
Business Website:

APPLICANT INFORMATION

First Name:
Last Name:
Your Title:
Date of Birth:

COMPANY INFORMATION

Are you an independent Barter Company or an independent Barter Broker ?	Company Broker
Do you have any reciprocal relationships with barter companies ?	Yes No

Business Establish Year:
Number of Employees:

Business Category:
Business Descripton:

How much customers do you have ?
What is your annual volume ?
How many listings do you currently have ?
What geographic area do you serve ?

REFERRALS

Please list three (3) trade exchanges that we may contact for character reference.

BANKER'S REFERENCE

Bank name:
Account holder name:
Bank account number:
Bank branch state:
Bank branch city:
Bank branch number:
Routing/Transit/Number:
Bank telephone number:

Is any principals or officers involved in a current or past bankruptcy ?	Yes No

How did you hear about CBC ?

I agree to the GTB of the CBC.

CONNex Holding Ltd.,
160a Brick Lane, 100 London,
United Kingdom
CBC-Barter www.cbc-barter.com