Barrett Agri Credit Application
This application is for in-house short term credit.
Contact Information
Company Name
*
Contact Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
In business since:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Amount of credit requested
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Corporate Officers/Partners/Sole Owners
Name
*
Name
Title
Phone Number
Email
Name
Name
Title
Phone Number
Email
Name
Name
Title
Phone Number
Email
Authorized Purchaser
*
Name
Title
Phone #
Email
Authorized Purchaser
Name
Title
Phone #
Email
Accounts Payable
*
First Name
Contact:
*
Name
Title
Phone #
Email
Purchase Orders required
*
Yes
No
Email for invoices:
*
example@example.com
Bank reference
*
Bank name
Phone number
City
State
Zip Code
Bank reference (Please complete both references and include email addresses)
*
Contact Name
Contact Email
Bank reference
Bank name
Phone number
City
State / Province
Postal / Zip Code
Bank reference (Please complete both references and include email addresses)
Contact Name
Contact Email
Trade reference (Please complete both references and include email addresses)
*
Company Name
Contact Name
Trade reference phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Trade reference email
*
example@example.com
Trade reference (Please complete both references and include email addresses)
*
Company Name
Contact Name
Trade reference phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Trade reference email
*
example@example.com
PLEASE NOTE
*
Standard credit terms are N10th unless previously agreed upon with sales manager. Outstanding balances are subject to 1.5% per month interest. The undersigned authorizes and release all banks, persons, and companies listed on this application to furnish information and authorize the checking of credit. The undersigned agrees to pay all collections costs, court costs and legal fees incurred to collect delinquent balances.
PERSONAL GUARANTEE
*
In consideration for credit extended, the undersigned contracts and guarantees to the faithful payment, when due, of all accounts of the company seeking credit for 5 years from the date of this application. The undersigned expressly waives all notice of acceptance of this guarantee, notice of extension of credit, present demand for payment and any notice of default by the company seeking credit and all other notices the gurantor might be entitled to. Revocation of the guarantee shall be in writing and delivered by certified mail.
Sign up for e-statements!
We encourage all new accounts to opt in for e‑statements. It’s our most secure and efficient way to keep you up to date on your account activity. Please contact Brooke at brooke@barrettagri.com or our office at 320-391-1435 to subscribe.
I have read and agree to the Terms of the Barrett Agri, Inc. Agreement and return policies.
*
*
Name
Title
Phone #
Email
Name
Title
Phone #
Email
Submit
Submit
Should be Empty: