NEVADA STATE CONTRACTORS BOARD
5390 KIETZKE LANE, SUITE 102, RENO, NEVADA, 89511 (775) 688-1141 FAX (775) 688-1271, INVESTIGATIONS (775) 688-1150
2310 CORPORATE CIRCLE, SUITE 200, HENDERSON, NEVADA, 89074 (702) 486-1100 FAX (702) 486-1190, INVESTIGATIONS (702) 486-1110
www.nscb.nv.gov
(Rev 9/14)
BANK VERIFICATION FORM
Name of Licensee/Applicant: _____________________________________________
Items 1 through 3 of the following report are to be completed by the applicant. Items 4 through 10 are to be completed by the
verifying bank. After completion by you and your bank, submit this form with your application.
1. Name and address of bank: ____________________________________________________
____________________________________________________
____________________________________________________
2. Signatures of account holder(s):
__________________________________ ______________________________________
Signature Print Name
__________________________________ _______________________________________
Signature Print Name
3. Information to be verified:
TO VERIFYING BANK: Please furnish the information requested below.
4. Classification of Account: Individual Corporation Partnership
Limited Partnership Limited Liability Company
5. Deposit accounts of applicants:
*Account Name Type *Account Number *Current Balance
*Date Opened
*Required Information
6. Verification of Lines of Credit:
Line of Credit
Account #
Type of
Credit Line
Date
Opened
Approved
Amount
Current
Balance
Payments Required Secured by
7. Additional information that may be of assistance in determination of credit worthiness:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
8. Affix Bank Stamp or Business Card 9. Name and Title of Bank Representative
of Bank Representative here
__________________________
__________________________
10: Date: ________________________
