Customer Restructure Questionnaire

To help you in a timely fashion, please:

  • Answer everything in as much detail as possible.
  • Use additional sheets/email if necessary.
  • Provide supporting documentation.
  • Return all materials in a single submission.

Return this completed Questionnaire as well as all supporting documentation within three days.

What are the primary reasons of your delinquency? Rank all applicable reasons by decreasing importance.
Issue within your business
Problem with equipment (not just the one we financed)
Non-performing customer(s) of yours
General industry trends
Personal medical emergency
Natural Disaster / National Emergency
What resources do you have to resolve your delinquency?
Financial resources: unused credit lines, new borrowings, additional Personal or Entity Guarantors, etc.
Other equipment you can deploy to generate revenues and profits
New/existing customers that can generate revenues and profits
How many other financial and trade creditors besides us are you currently delinquent with?
CreditorFinancing TypeDelinquent Amount (Principal or Total Payables)
Files must be less than 3 MB.
Allowed file types: jpg jpeg png pdf.