Farmer's Co-Op Credit Application

Farmer's Co-Op Credit Application

PLEASE NOTE: Fields marked with an Asterick (*) ARE required fields and if not filled in your application will not submit.
When we receive your application, a Farmer's Co-Op Representative will call you for your social security number and bank account information to complete your online application.
BUSINESS CONTACT INFORMATION
Your Title
Company Name*
Company Phone*
Please enter a valid phone number.
Company FAX
Company Email*
example@example.com
Registered Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Business Commenced
Sole Proprietorship?

YesNo
Partnership?

YesNo
Corporation?

YesNo
Other?
Please State
Business and Credit Information
Primary Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How Long at Current Address?
Round Up In Years
Primary Telephone*
Please enter a valid phone number.
Primary FAX*
Primary Email*
example@example.com
Business / Trade References
1) Company Name
1) Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
1) Company Phone
Please enter a valid phone number.
1) Company FAX
1) Company Email
example@example.com
1) Type of Account
2) Company Name
2) Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
2) Company Phone
Please enter a valid phone number.
2) Company FAX
2) Company Email
example@example.com
2) Type of Account
3) Company Name
3) Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3) Company Phone
Please enter a valid phone number.
3) Company FAX
3) Company Email
example@example.com
3) Type of Account
Agreement

All Invoices are to be paid 30 days from Statement Date. By submitting this Application, you authorize Farmer's Co-Op Association to make inquiries into the Banking and Business/Trade References you have supplied.
Signatures
1) Signature
Type Your Name As It Appears On Your Accounts
1) Title
1) Date
2) Signature
Type Your Name As It Appears On Your Accounts
2) Title
2) Date
Should be Empty:

Farmer's Co-Op Credit Application

BUSINESS CONTACT INFORMATION

Business and Credit Information

Business / Trade References

Agreement

Signatures