Commercial Credit Application

P.O. Box 69 Outlook, Saskatchewan, Canada

Telephone: 1(306) 867-8614 Fax: 1(306) 867-1812 E-mail: admin@riverbendcoop.com

1. Identification

Is this application for a Corporate Farm?

YesNo

Patronage Number

Name of Applicant

Telephone

Fax

Name of Partner

Telephone

Fax

Trade Name/Business Name (if different from above)

Address (if P.O. Box provide Street Address as well)

City/Town

Province

Postal Code

2.) Business Information

Nature of Business

GST #

PST #

Type of Business

CorporationPartnershipSole ProprietorshipOther

Length of Time in Business

Years Incorporation Date

Date

# of Employees

Accounts Payable Contact

Telephone

If a Subsidiary, Branch or Division, please state Parent Corporation:

Name

Phone #

Fax #

Address

Postal Code

City/Town

Province

Financial Statements for Year Ending

Financial Statements Prepared and will provide copy?

YesNo

Please e-mail Financial Statements to credit@riverbendcoop.com

Financial Information provided will be held in strict confidence and used for credit purposes only.

	Officers, Partners or Owner’s Name	Title	Home Address (Partners or Owner)-	Birth Date (MM/DD/YY)
1
2
3
4

3. References

Financial Institution Name

Account Manager

Address

Account#

Telephone

Current Trade Supplier Name Address Telephone

Financial Information provided will be held in strict confidence and used for credit purposes only.

	Current Trade Supplier Name	Address	Telephone#
1
2
3

4. COMPLETE THIS PORTION FOR CORPORATE FARM USE

Section

Township

Range

West of

How long have you farmed

Acres Farmed

Do you have livestock? Is Livestock Financed by a 3rd Party

YesNo

If livestock is financed, then by who?

# of Livestock

Name of Insurance Agent

5. Account Information

Estimated Monthly Co-op Purchases

Credit Limit Desired

I/we certify that the above information is true. I/we certify that I/we are entering into this credit agreement primarily for commercial purposes (that is, not personal, family, or household purposes), or for corporate farming purposes. I am/we are at least the minimum adult age. I/We understand the Co-op may accept or reject this application. If this credit application is accepted, I am/we are bound by the Co-op’s Commercial/Corporate Farm Credit Agreement and Statement of Disclosure. Where a partner signs this application with me, we acknowledge that the terms of this application and all consents given in it bind both of us. We agree to be jointly and individually liable, which means we are liable both individually and together for all amounts charged to the account. If this application is made by a corporation, each of the above statements is considered to be made by an authorized person on behalf of the corporation with all necessary grammatical changes.

I/we understand that purchases made during a calendar month of this Co-op account are payable in full by the last day the following month. On any amount that is not paid, I/we agree to pay a service charge of 24% per annum (2.0% per month) calculated monthly and added to the account until the account has been paid in full or made current within the terms arranged and I/we shall be responsible for collection costs incurred in recovering the full amount of my unpaid account. Any payments on this account which do not pay the account in full will be applied firstly, to pay service charges and secondly, to reduce the principal outstanding.

I/We/the Corporation consent(s) to the exchange of account and credit information and personal information from time to time by the Co-op and the financial references provided and to the exchange of credit information with credit grantor, credit bureau, credit reporting agency, or my/our employer(s)

Date

Corporate Applicant’s Name

Individual Applicant's Signature

Name & Title

Partner's Signature (if applicable)

Name & Title

Partner Signature # 2 (if applicable)

Name & Title

Commercial & Corporate Farm Application

OVER

Please Read, Date and Sign