AND ITS RELATED BUSINESSES
1947 Briarfield
PO Box
Blvd.
119* PO Box 119
Maumee, OH 43537-0119
Phone: 419-893-5050 ; Fax 419-897-6767
e-mail: [email protected]
For Andersons use only
Location/Salesrep
Grain
A/R #:
COMMERCIAL CREDIT APPLICATION - FARM OPERATION
Applicant name:
Date:
Principal:
SSN/FEID:
Principal:
SSN/FEID:
Billing address:
Yrs in business:
City:
County:
Phone # :
State:
Fax #:
Principal's cell #:
e-mail address:
Type of organization:
Line of business:
Corporation
Partnership
Sole Ownership
Will your purchases be exempt from sales tax?
LLC
Other:__________
Please provide exemption certificate
YES
Requested
Credit Limit: $
Zip:
NO
If credit limit requested is in excess of $50,000, please attach copy of your most recent
annual financial statement. All information is kept confidential.
Has applicant or any principal of applicant ever filed bankruptcy?
Yes
No.
If yes, date filed, where, & case number:
Is applicant or any principal of applicant involved as a defendant in any lawsuit or other disputes?
Yes
Indicate court & case number:________________________________________________________________________
No
Years farmed:________
Acres owned:__________
Acres rented:___________
Total acres farmed:_____________
Total assets: $__________
Total liabilities:$___________
Gross farm income:$_________ Total farm expenses:$_________
Do you have a restricted use pesticide license? _______Yes _______No If yes, number and date of expiration:____________
Commodity produced:_______________ Typical yield_________ ; Commodity produced:_____________ Typical yield_________
Commodity produced:_______________ Typical yield_________ ; Commodity produced:_____________ Typical yield_________
Number and type of livestock owned:________________________________________________________________________
Are any of these crops and livestock currently under lien? _____Yes _____No ; If Yes, please describe, name & phone number:
Do you have a farm operating loan? _____Yes _____No If Yes, name & phone # of lending institution:
Do you have crop insurance? ____Yes ____No; If yes, name & phone # of agent:_______________________________________
Do you have off farm employment? ____Yes ____No; If yes, amount of annual income $_____________
Name & phone number of employer:____________________________________________________________________________
Name:
Name:
Name:
City/ST/Zip:
City/ST/Zip:
City/ST/Zip:
Account #:
Account #:
Account #:
Phone #:
Phone #:
Phone #:
Fax #:
Fax #:
Fax #:
Institution name:
Institution name:
Institution name:
City/ST/Zip:
City/ST/Zip:
City/ST/Zip:
Account #:
Account #:
Account #:
Fax #:
Fax #:
Fax #:
SEE REVERSE SIDE FOR TERMS, CONDITIONS AND SIGNATURE
Page 1
This applicatio n, alo ng with these credit terms and co nditio ns, financial statements and o ther do cuments (Do cuments) are submitted by A pplicant to The A nderso ns, Inc.
and its related businesses whether who lly-o wned o r in which The A nderso ns, Inc. has an o wnership interest (A nderso ns) fo r the so le purpo se o f o btaining credit fro m
A nderso ns. Upo n appro val o f A pplicant's credit, the do cuments set fo rth the entire agreement between A pplicant and A nderso ns regarding the matters described herein
and supersede all prio r o ral o r written agreement in respect thereo f. In the event that a sale was to an applicant in reliance o n any misrepresentatio n made by such
applicant, the amo unt o wing fro m such sale is due immediately upo n demand.
If credit is extended to A pplicant, A pplicant may be required to perio dically furnish to A nderso ns current financial statements that are in reaso nable detail and certified as
true and accurate o n the date submitted by A pplicant.
A pplicant hereby co nsents to A nderso ns' use o f no n-business co nsumer credit o n the A pplicant, if A pplicant is so le pro prieto rship, in o rder to further evaluate the credit
wo rthiness o f the A pplicant as principal(s), pro prieto r(s) and/o r guaranto r(s) in co nnectio n with the extensio n o f business credit. A pplicant hereby autho rizes A nderso ns
to utilize a co nsumer credit o n the A pplicant fro m time to time in co nnectio n with the extensio n o r co ntinuatio n o f the business credit resresented by this credit applicatio n.
A pplicant as (an) individual(s) hereby kno wingly co nsent(s) to the sue o f such redit repo rt co nsistent with the Fair Credit Repo rting A ct as co ntained in 15 U.S.C Sec 1681
et seg.
No disco unts are to be taken by A pplicant o n any invo ice witho ut prio r written autho rizatio n o f A nderso ns.
Invo ice terms are as stated o n all invo ices and lease agreeements.
A cco unts beco me delinquent when no t paid within invo ice terms. Delinquency charges/rate are stated o n all invo ices and/o r in lease agreements. In no event shall the rate
exceed the maximum amo unt permitted under applicable law. The charges will be co mputed acco rding to A pplicant's delinquent balance and auto matically added to the
mo nthly statement. If no delinquency rate is stated o n invo ice o r in lease agreement, the annual delinquency rate shall be 18%.
A pplicant agrees that venue shall be determined by A nderso ns.
A nderso ns reserves th eright to revo ke o r suspend A pplicant's credit privileges at A nderso ns' so le discretio n.
Credit will be terminated fo r acco unts no t active fo r two (2) years. A t A nderso ns' so le discretio n, failure to pay any invo ice when due may result,in A nderso ns' exercise o f its
remedies o f default uunder a lease agreement o r in the terminatio n o f said credit with any and all mo nyes o utsatanding, whether duw o r no t, payable upo n demand o f A nderso ns.
A ny check, mo ney o rders, instruments tendered to A nderso ns in full satisfactio n o f any disputed debts, shall be sent to : The A nderso ns, Inc., Treasury Department A cco unts Settlement, P O B o x 119, M aumee, OH 43537. No endo rsement o r statement o n any check o r any letter acco mpanying any check shall be
deemed binding o n A nderso ns o r deemed an acco rd and satisfactio n. A nderso ns may accept a check o r payment fro m A pplicant witho ut prejudice to A nderso ns' right
to reco ver the balance o f any amo unts o wing by A pplicant, and witho ut limitatio n o n A nderso ns' right to pursue each and every remedy existing at law, in equity, by state
o r o therwise. Yo ur acco unt may be charged a fee plus delinquency fee fo r pro cessing each returned check o r returned EFT draft.
A cceptance o f any perfo rmance by A nderso ns, after breach o f these terms o r any amended terms by A pplicant, shall no t act as a waiver o f any rights o r remedies to
which A nderso ns wo uld o therwise be entitled as a result o f such breach.
A t A nderso ns' o ptio n, if A pplicant's acco unt beco mes delinquent, A nderso ns shall have the right, immediately and witho ut further no tice to A pplicants, to o ff-set against
A pplicant's acco unt, all amo unts o wed to A pplicant by A nderso ns in any capacity.
The respective rights, o bligatio ns and liabilities o f A pplicant's successo rs and assignes. A pplicant shall give A nderso ns pro mpt no tice o f any change in A pplicant's fo rm
o f structure.
A pplicant will be respo nsible fo r repo rting to nnage and paying all inspectio n fees to the applicable state(s) agencies o f pro ducts so ld to /purchased fro m A nderso ns and
distributed in, o r within the state(s). It is understo o d that this do es no t change any o ther to nnage repo rting and inspectio n fee payment o bligatio ns o f the A pplicant. It is also
understo o d that the A pplicant is required to maintane current registratio ns status with the applicable state(s) agencies and to submit a to nnage repo rt and pay appro priate
inspectio n fees to the applicable state(s) agencies.
Whether signed manually belo w o r signed by electo nic means, A pplicant hereby certifies that the info rmatio n given o n the applicatio n is true to the best
o f A pplicant's kno wledge. A pplicant autho rizes release o f all relevant info rmatio n to A nderso ns, including, but no t limited to acco unt info rmatio n, including
o pen grain co ntracts and deliveries, financial disclo sures, financial institutio n acco unts, credit repo rts, o r o ther similar credit reso urces. A pplicant
ackno wledges A nderso ns is relying o n the financial and o ther info rmatio n pro vided by A pplicant herein, in making its decisio n o n whether to extend credit
to A pplicant. A lso , A pplicant certifies that the credit will be used fo r co mmercial purpo se o nly, and no t fo r private, individual purpo ses. A pplicant
ackno wledges that the abo ve terms represent co ntractual o bligatio ns to A pplicant and A pplicant agrees to pay the delinquency charges and the
terms co ntained herein, and further agrees to pay all co sts o f co llectio n, including but no t limited to , reaso nable atto rney fees, co urt co sts,
resto cking charges up to 10%, if applicable, and o ther asso ciated co sts.
PLEASE PROVIDE A SALES TAX EXEMPT CERTIFICATE, OTHERWISE ALL PURCHASES WILL BE CHARGED APPLICABLE SALES TAX.
APPLICANT'S NAME
APPLICANT'S SIGNATURE / TITLE
DATE
APPLICANT'S SIGNATURE / TITLE
DATE
The Andersons, Inc.
©
3/17
Page 2
Division
AND ITS RELATED BUSINESSES
PO Box 119
Maumee, OH 43537
419-893-5050 * Fax 419-897-6767
e-mail: [email protected]
A/R#
Customer Name:
The Customer agrees to the ACH Debit method for payment. The Andersons, Inc. and its related businesses
will initiate such debits by ACH Debit out of the Customer's bank account at the financial institution specified below.
Please note the Customer will be notified in advance of any such debit.
Institution name:
Address:
City:
ST:
Zip:
ABA Routing/Transit Number: (9 digit)
Account number:
Account Type
(check one)
Checking
Bank contact name:
Savings
Bank contact phone number:
Client contact:
Client phone:
Client e-mail address:
Authorized signature (must be an authorized signatory on account listed)
Signature
Title:
Date:
This authorization shall remain in effect unless and until revoked in writing by an authorized representative
of Customer and until The Andersons, Inc. and its related businesses have received such notice and have
reasonable time to act upon such notice.
The Andersons, ©
2016