Barrett Agri Credit Application

Barrett Agri Credit Application

320-391-1435
Contact Information
Company Name*
Contact Name*

First NameLast Name
Phone Number*
Email*
example@example.com
In business since:*

MonthDayYear
Date
Amount of credit requested*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Corporate Officers/Partners/Sole Owners
Name*

NameTitlePhone NumberEmail
Name

NameTitlePhone NumberEmail
Name

NameTitlePhone NumberEmail
Authorized Purchaser*

NameTitlePhone #Email
Authorized Purchaser

NameTitlePhone #Email
Accounts Payable*

First Name
Contact:*

NameTitlePhone #Email
Purchase Orders required*

YesNo
Email for invoices:*
example@example.com
Bank reference*

Bank name

Phone number

CityState

Zip Code
Bank reference (Please complete both references and include email addresses)*

Contact NameContact Email
Bank reference

Bank name

Phone number

CityState / Province

Postal / Zip Code
Trade reference (Please complete both references and include email addresses)*

Company NameContact Name
Trade reference phone number*
Please enter a valid phone number.
Trade reference email*
example@example.com
Trade reference (Please complete both references and include email addresses)*

Company NameContact Name
Trade reference phone number*
Please enter a valid phone number.
Trade reference email*
example@example.com
PLEASE NOTE

Credit terms are N10th. 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 the credit extended, the undersigned contracts and guarantees 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 any notice of default by the company seeking credit, and all other notice the guarantor might be entitled to. Revocation of the guarantee shall be in writing and delivered by certified mail.
Statement Fee Notice

Please note that paper statements and invoices will be charged $5 per month. You can opt out of this charge by subscribing to e-statements. Please contact jhermes@barrettagri.com to subscribe.
I have read and agree to the Terms of the Barrett Agri, Inc. Agreement and return policies.*

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Barrett Agri Credit Application

Contact Information

Corporate Officers/Partners/Sole Owners

PLEASE NOTE

Statement Fee Notice