The John Reynolds Group Ltd Stamford House, Northenden Road Sale, Manchester M33 2DH Tel: 0161 905 5500 Fax: 0161 905 5510

Please complete and submit for a no-obligation quote Note: All figures quoted on this form are to exclude VAT. Alternatively, please state if the figures include VAT. Company: Your name: Position: Telephone: Fax: Email: Address: Postcode: Business Description: Estimated Turnover on Credit Terms (next 12 months) Domestic: £ Export: £ (please attach a list of export markets and respective turnover) Debtor balance at last: March: £ June: £ Sept: £ Dec: £ Past Analysis:   Current Year Last Year Previous Year Previous Year Turnover Total Bad Debts Largest How Many Name of Largest Please list any special features to your trade - e.g. long term contracts, work in progress, consignment stock etc. Debtor Analysis as at:   - - (dd-mm-yyyy) Exposure Amount Outstanding Number of Debtors Under £1,000 £1,001 - £2,500 £2,501 - £5,000 £5,001 - £10,000 £10,001 -£25,000 £25,001 -£50,000 £50,001 - £100,000 £100,001 - £250,000 £250,001 - £500,000 £500,001 - £1,000,000 Over £1,000,000 Normal payment terms given to debtors: Maximum payment terms given to debtors: Which of the following do you utilise in setting credit limits: Bank Reports Yes  No Level £ Trade Reference Yes  No Level £ Reports and Accounts Yes  No Level £ Status Reports Yes  No Level £ Which Status Agencies do you use?    How often is the information updated?    Who is responsible for approving and increasing credit limits? Position:   Name: Level: £ Position:   Name: Level: £ Who is responsible for cancelling and reducing credit limits? Position:   Name: Level: £ Position:   Name: Level: £ Overdue accounts procedure: How many days past due date would you: Make a telephone call? Take recovery / collection action? Send a letter? Take legal action? Stop further supplies? Current credit insurance arrangements: Renewal date: Insurance company: Broker: Type of policy: Please provide details of your largest debtors (UK and/or Export): Full Trading name and registration number/address Credit limit Current balance £ £ £ £ £ £ £ £ £ £ £ £ £ £ Please detail any seriously overdue accounts which are giving you cause for concern: Name of debtor Amount outstanding Action taken £ £ £ £ Please outline any additional information which you feel may support your application for credit insurance: