MidSouth Ag Source New Customer Form Logo
  • **Tax Exemption Card**

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  • **Restricted Use Pesticide License**

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  • **DO NOT FILL OUT IF YOU DO NOT WANT TO APPLY FOR CREDIT**

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  • Credit Application Form

  • Business Contact Information

  •  Midsouth Ag Source
     1211 West Wood St, Paris, TN
     Phone: 731-407-4986
     Email: sales@midsouthagsource.com
     Website: www.midsouthagsource.com

  • Applicant Information

  • Credit References

  • Credit Reference #1

  • Credit Reference #2

  • Credit Reference #3

  • Credit Account Terms & Conditions

  • By signing below, you acknowledge and agree to the following terms for establishing a credit account with Midsouth Ag Source:

    1. Credit Check Authorization: I authorize Midsouth Ag Source to perform a credit check and verify all information provided herein.
    2. Finance Charges: Any outstanding balance will be subject to a finance charge at an Annual Percentage Rate (APR) of 18%.
    3. Late Payment Fee: In the event that payment is received past the due date, a minimum late fee of $25 will be applied.
    4. Credit Limit: Your credit limit will be determined at the discretion of Midsouth Ag Source based on creditworthiness and account history.
    5. Payment Terms: Payment is due as per the invoice issued. Failure to remit payment by the due date may result in suspension or termination of your credit account.
    6. Documentation: You agree to provide any necessary documentation (e.g., valid identification and, if applicable, a tax exemption certificate) to support your credit application.
    7. Liability: In the event of misuse or nonpayment, you understand that you may be held personally liable for any outstanding balance on your account.
    8. Governing Law: This credit account agreement is governed by the laws of the State of Tennessee.

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