VERIBANC - Order Request

ORDER REQUEST FORM

Please provide the following contact information, as we will call
you to confirm this request and obtain payment information:

First Name:	M.I.:	Last Name:	Organization:

Address:

City:	State:	Zip Code:	Country:

Work Phone:	Home Phone:	E-mail (required):	Best Time to Call:

Please provide the following report(s):

Bank Reports
Individual Institution Reports	Lists of Institutions Reports
Instant Rating	Blue Ribbon Bank Marketing Tools
Bank Short Form	Blue Ribbon Bank Selected Region #:
Bank Research	Blue Ribbon Bank - Entire U.S.
VERIFAX	State Ratings - See Mixed Institution Reports
Real Estate Investors'	Everything Report - See Mixed Institution Reports
Custom (individual or lists)	State 50 Report -See Mixed Institution Reports

Credit Union Reports
Individual Institution Reports	Lists of Institutions Reports
Instant Rating	Credit Union State Ratings
Credit Union Short Form	Credit Union Everything Report with Data
Credit Union Research	Credit Union Everything Report - No Data
Custom (individual or lists)	Credit Union State 50

Holding Company Reports*
Holding Company Short Form	Holding Company Research
Custom (individual or lists)	* Aggregations of bank subsidiaries only.

Savings Association (S&Ls) Reports
Individual Institution Reports	Lists of Institutions Reports
Instant Rating	State Ratings - See Mixed Institution Reports
Savings Association Short Form	Everything Report - See Mixed Institution Reports
Savings Association Research	State 50 Report -See Mixed Institution Reports
Real Estate Investors'	Custom (individual or lists)

Mixed Institution Type Reports (Banks, Savings Associations, or Credit Unions)
Instant Ratings	Bankers' Priority
Bank and Thrift State Ratings	Bank and Thrift State 50
Bank and Thrift Everything Report with Data	Bank and Thrift Everything - No Data
Internet Watchlist	US 50
Regulatory Enforcement Actions	Regulation - "F"
Watchlist (Banks, Thrifts, & Credit Unions)	Custom (individual or lists)

These are the institutions I am interested in (if applicable):

If you have more than five (5) institutions please list them
in the "Additional Comments" area below.

Additional Comments: