Check One Select Credit Application and Agreement
Check One
This section to be completed by a CVA employee. CVA Location: CVA Employee:
Individual Partnership Corporation LLC LLP
Select
Credit Application and Agreement
Agricultural Producer Non-Agricultural Patron
Account # ___________________________
All items MUST be fully completed and application MUST be signed before returning it to Central Valley Ag Full Legal Name: Current Address: City: State: Years/Months at above address: Previous Address (if less than 3 years at current address): City: State: Present Employer: Length of Employment:
Zip:
Zip:
SSN or FEIN: Date of Birth: Phone: ( ) Email address:
-
Years/Months at:
Annual Salary (excluding farming or ranching income):
(if seeking a joint account, include joint applicant's information on second page)
Financial Information: Current Financial Institutions for Loans and Deposits / Contact Person: 1. Account #: Address: 2. Account #: Address:
Phone: Phone:
Credit References: 1. 2.
Address: Address:
Phone: Phone:
List the maximum dollar amount to be purchased in any one month period under convenience credit. 1. Feed / Animal Health
$
4. Grain
$
2. Fertilizer / Chemical / Seed
$
5. Misc.
$
3. Propane / Fuels / Lubes
$
TOTAL
$ (Maximum per one month period)
Note to new Patrons: As a cooperative, Central Valley Ag classifies its patrons as stockholders if they are active agricultural producers or certificate of participation holders if they are non-agricultural patrons. When the Cooperative allocates patronage to new patrons the first time, it will deduct from the cash portion of the patronage ten dollars ($10) which will be used to pay for the face value of the share of common stock or the certification of participation. The remaining non-cash portion of any patronage allocation will be allocated on the books of the Cooperative as Members’ Equity Credits. The undersigned stockholder or patron of Central Valley Ag, York, Nebraska hereby gives consent that the amount of any distribution with respect to its patronage, which are made in qualified written notices of allocation (which means any capital stock, revolving funds, certificates, retain certificate, certificate of indebtedness, letter of advice, or other written notice; which discloses to the patron the stated dollar amount allocated to it and the portion thereof, in any, which constitutes a patronage dividend) and which are r eceived from the Central Valley Ag, York, Nebraska, will be taken into account by stockholder/patron at their stated dollar amounts in the manner provided in the Revenue Act of 1962 in the taxable year in which such wr itten notices of allocation are received by stockholder/patron. I, the undersigned, have read the Credit Agreement and agree to the terms of that agreement and the Consent To Account For Patronage.
I/We authorize Central Valley Ag to make whatever credit inquiries that it deems necessary in connection with this credit application or in the course of review of collection of any credit extended in reliance on the application. I/We authorize and instruct any person or consumer reporting agency to complete and furnish to Central Valley Ag any information it may have or obtain in response to such credit inquiries and agree that such information, along with this application, shall remain Central Valley Ag’s property whether or not credit is extended. I/We further understand that all authorized charges to my/our account are my/our obligations, regardless of personal agreements with other parties, renter or tenants of our land or dwellings, unless they have applied for, received and used their own account for acquiring goods and services. All information set forth in this application is declared to be a true representation to the facts, made for the purpose of obtaining the credit requested and any willful misrepresentation on this application could result in criminal action. Notice: The Federal Equal Credit Opportunity Act prohibits creditors from discrimination against credit applications on the basis of sex or marital status. The Federal agency which compliance with this law concerning this cooperative is: Federal Trade Commission, Denver Regional Office 1405 Curtis Street, Suite 2900 Denver, CO 80202 IF THE CUSTOMER IS A CORPORATION OR OTHER ENTITY, THE PERSON EXECUTING THIS AGREEMENT AGREES TO PERSONALLY GUARANTEE THE PAYMENT OF ALL AMOUNTS DUE FROM THE CUSTOMER TO CENTRAL VALLEY AG. CENTRAL VALLEY AG MAY ALSO REQUIRE A PERSONAL GUARNTEE FROM OTHER INDIVIDUALS AS A CONDITION FOR RECEIVING CREDIT. THE CREDIT AGREEMENT OF CENTRAL VALLEY AG IS INCORPORATED INTO AND A PART OF THIS CREDIT APPLICATION AND AGREEMENT. I/WE ACKNOWLEDGE RECEIPT OF THE CREDIT AGREEMENT OF CENTRAL VALLEY AG AND AGREE TO BE BOUND BY ITS TERMS AND CONDITIONS. I/WE FURTHER ACKNOWLEDGE RECEIPT OF THE REQUIRED FRDERAL DISCLOSURES. I/WE GIVE CENTRAL VALLEY AG PERMISSION TO CONFIRM FINANCING ARRANGEMENTS MADE WITH THE ABOVE LENDING INSTITUTIONS.
Applicant’s Signature: __________________________________________________________________________________
Date: ________________________
Joint Applicant or Guardian: ___________________________________________________________________
Date: _____________________________
Revised: 6/15/2015
Account # __________________________
Joint Applicant Information: (complete ONLY if seeking a joint account and using joint applicant's income for credit consideration) Full Legal Name: Current Address: City: State: Years/Months at above address: Previous Address (if less than 3 years at current address): City: State: Present Employer: Length of Employment:
Zip:
Zip:
SSN or FEIN: Date of Birth: Phone: ( ) Email address:
-
Years/Months at:
Annual Salary (excluding farming or ranching income):
Revised: 6/15/2015
CENTRAL VALLEY AG
Credit Agreement Central Valley Ag, herein after referred to as the “Co-op” offers convenience credit to qualified patrons. Convenience credit should not be construed as a line of credit for long term financing. Patrons using convenience credit must follow the terms of this Credit Agreement and associated policies, applications, agreements, guarantees or forms in order to remain eligible for convenience credit. The Co-op considers the extension of convenience credit as a service to the patrons and not as a right. The Co-op reserves the right to deny or limit the extension of credit to any patron when such denial or limit is in the best interest of the Co-op. Every patron who does business with the Co-op shall be deemed to have agreed to be bound by the provisions of this Credit Agreement. The Credit Agreement of the Co-op is subject to change without prior notice. Upon approval of credit for the Customer, the Co-op will allow the Customer to make purchases of products and services on credit and Customer agrees to pay for the products in accordance with this Agreement. DUE DATE
All purchases on credit will be stated on the monthly invoice statement rendered by the Co-op as of the last business day of the month. The statements are due and payable by the 20th of the month following statement.
DELINQUENCY CHARGE AND INTEREST CHARGE
Any unpaid invoice statement balance or portion thereof not paid by the DUE DATE will be subject to a DELINQUENCY CHARGE of 5% which will be added to the invoice balance. In addition to the Delinquency Charge, an INTEREST CHARGE of 1.33% per month will be assessed on the last day of the month following the statement date on all unpaid balances existing as of that date.
TERMINATION OF CREDIT
The Co-op reserves the right to terminate credit sales at any time without prior notification. No amount of additional sales of products on credit will be allowed if the account has a past due balance more than 45 days following the statement date.
CHANGE IN TERMS
Credit terms may be changed at the discretion of the Co-op including, but not limited to, changing the due date, changing the billing cycle, LIMITING THE AMOUNT OF APPROVED CREDIT, or on any other matter after notice of such change has been given to the Customer.
DISPUTED STATEMENT
All invoices and statements rendered by the Co-op will be conclusive as to the items purchased and charges therefor unless the Customer informs the Co-op in writing of a dispute thereon within 10 days of the statement date.
GUARANTY
If the Customer is a corporation or other entity, the person executing this Agreement, in order to induce the Co-op to grant Credit to the corporation or other entity, hereby agrees to personally guarantee the payment of all amounts due from the Customer to the Co-op. The Cooperative may further require separate personal guarantees from other stockholders, members, partners, whomsoever, in granting credit to a corporation or other entity.
NO WAIVER RIGHTS
Neither an extension of time for payment granted to the Customer, if any, nor acceptance of partial payment by the Co-op, if any, shall constitute a waiver of any right to full payment of all sums due and owing to the Co-op by the Customer.
RIGHT OF OFFSET
Customer agrees that the Co-op may offset and apply any amounts it may from time to time owe the Customer for whatever reason against any unpaid past due credit balance of the Customer.
ADMINISTRATIVE CHARGES
The Co-op may assess a reasonable charge to offset the additional administrative costs incurred by the Co-op when a Customer pays all or a portion of his or her convenience credit account balance by credit card. Such charges shall be added to the Customer’s convenience credit balance prior to completing the credit card payment transaction.
DISPUTE RESOLUTION
This Credit Agreement, including any action to collect past due balances, enforce personal guarantees or litigate product claims for products purchased on credit may be enforced in any Court of competent jurisdiction in the State of Nebraska. Applicant, guarantor and Co-op, to the fullest extent possible waive any claim that the forum is not convenient. Applicant, guarantor and Co-op further, to the fullest extent allowed by law waive their right to a trial by jury.
Applicant agrees that the Co-op may establish other credit terms, require security and participate in shared financing arrangements as it deems necessary in its sole discretion. Adopted by the Board of Directors of Central Valley Ag Cooperative on July 1, 2014.
Applicant’s Signature: ____________________________________________________________________ Date: _____________________
Joint Applicant or Guardian: ________________________________________________________________ Date: _____________________
Revised: 6/15/2015
RESET FORM
PRINT FORM
Nebraska Resale or Exempt Sale Certificate
Form
for Sales Tax Exemption
Name and Mailing Address of Purchaser
Name and Mailing Address of Seller
Name
13
Name
Central Valley Ag Cooperative Legal Name Street Address (Do not use PO Box)
Street or Other Mailing Address
PO Box 429 City
State
Zip Code
City
State
NE
York
Zip Code
68467
Check Type of Certificate
c Single Purchase
If single purchase is checked, enter the related invoice or purchase order number ______________________________________.
c Blanket
If blanket is checked, this certificate is valid until revoked in writing by the purchaser.
I hereby certify that the purchase, lease, or rental by the above purchaser is exempt from the Nebraska sales tax for the following reason:
Check One
c Purchase for Resale (Complete Section A.)
c Exempt Purchase (Complete Section B.)
c Contractor (Complete Section C.)
Section A — Nebraska Resale Certificate
Description of Property or Service Purchased
I hereby certify that the purchase, lease, or rental of ________________________________________________________________from the seller listed above is exempt from the Nebraska sales tax as a purchase for resale, rental, or lease in the normal course of our business. The property or service will be resold either in the form or condition in which it was purchased, or as an ingredient or component part of other property or service to be resold. I further certify that we are engaged in business as a: c Wholesaler c Retailer c Manufacturer c Lessor of Description of Product or Service Sold, Leased, or Rented ___________________________________________________________________________________________________________________. My Nebraska Sales Tax Permit Number is 01-_________________________________. If none, state the reason _____________________________________________________________________________________________________, or Foreign State Sales Tax Number__________________________________________ State __________________________________________.
Section B — Nebraska Exempt Sale Certificate The basis for this exemption is exemption category ______ (insert appropriate number for the category of exemption described on the reverse side). If exemption category 2 or 5 is claimed, enter the following information: Description of Items Purchased
Intended Use of Items Purchased
_________________________________________________________________________________________________________________________. If exemption category 3 or 4 is claimed, enter your Nebraska Exemption Certificate number. 05 -______________________________ Do not enter your Federal Employer ID Number.
If exemption category 6 is claimed, the seller must enter the following information and sign this form below: Description of Items Sold
Date of Seller’s Original Purchase
Was tax paid when purchased by seller?
c Yes
c No
Was item depreciable?
c Yes
c No
Section C — For Contractors Only 1. Purchase of building materials or fixtures.
c As an Option 1 or Option 3 contractor, I hereby certify that the purchase of building materials and fixtures from the seller listed above are exempt from Nebraska sales tax. My Nebraska Sales or Use Tax Permit Number is: _____________________________________________________.
2. Purchases made by an Option 2 contractor under a Purchasing Agent Appointment on behalf of_________________________ (exempt entity) ________________________________________. As an Option 2 contractor, I hereby certify that the purchase of building materials and fixtures from the seller listed above is exempt from Nebraska sales tax pursuant to the attached Purchasing Agent Appointment and Delegation of Authority for Sales and Use Tax, Form 17. Any purchaser, agent, or other person who completes this certificate for any purchase which is not for resale, lease, or rental in the regular course of the purchaser’s business, or is not otherwise exempted from sales and use taxes is subject to a penalty of $100 or ten times the tax, whichever amount is larger, for each instance of presentation and misuse. With regard to a blanket certificate, this penalty applies to each purchase made during the period the blanket certificate is in effect. Under penalties of law, I declare that I am authorized to sign this certificate, and to the best of my knowledge and belief, it is correct and complete.
sign here
Authorized Signature
Title
Date
Authorized Signature Name (please print)
Do not send this certificate to the Nebraska Department of Revenue. Keep it as part of your records. Sellers cannot accept incomplete certificates. 6-134-1970 Rev. 10-2014 revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729 Supersedes 6-134-1970 Rev. 3-2009
Instructions
Who May Issue a Resale Certificate. Form 13, Section A, is issued by persons or organizations making purchases of property or taxable services that will subsequently be resold in the purchaser’s normal course of business. The property or services must be resold in the same form or condition as when purchased, or as an ingredient or component part of other property that will be resold. Who May Issue an Exempt Sale Certificate. Form 13, Section B, may only be issued by governmental units and persons or organizations that are exempt from paying Nebraska sales and use tax. Nonprofit organizations that are exempt from paying sales and use tax are listed in the Nebraska Sales Tax Exemption Chart.
Enter the appropriate number from the “Categories of Exemption” in the space provided that properly reflects the basis for your exemption. If category 2 through 6 is the basis for exemption, you must complete the information requested in Section B. For additional information about proper issuance and use of this certificate, please review Reg-1-013, Sale for Resale – Resale Certificate, and Reg-1-014, Exempt Sale Certificate. Contractors. To make tax-exempt purchases of building materials and fixtures, Option 1 or Option 3 contractors must complete Form 13, Section C, Part 1. To make tax-exempt purchases of building materials and fixtures pursuant to a construction project for an exempt governmental unit or an exempt nonprofit organization, Option 2 contractors must complete Form 13, Section C, Part 2. The contractor must also attach a copy of a properly completed Purchasing Agent Appointment and Delegation of Authority for Sales and Use Tax, Form 17, to the Form 13, and both documents must be given to the supplier when purchasing building materials. See the contractor information guides for additional information. When and Where to Issue. The Form 13 must be given to the seller at the time of the purchase to document why sales tax does not apply to the purchase. The Form 13 must be kept with the seller’s records for audit purposes (see Reg-1-012, Exemptions). Do not send Forms 13 to the Nebraska Department of Revenue. Sales Tax Number. A purchaser who is engaged in business as a wholesaler or manufacturer is not required to provide an ID number when completing Section A. Out-of-state purchasers may provide their home state sales tax number. Section B does not require a Nebraska ID number when exemption category 1, 2, or 5 is indicated. Fully Completed Resale or Exempt Sale Certificate. For a resale certificate to be fully completed, it must include: (1) identification of the purchaser and seller, type of business engaged in by the purchaser, and reason for the exemption; (2) sales tax permit number; (3) signature of an authorized person; and (4) the date of issuance. For an exempt sale certificate to be fully completed, it must include: (1) identification of purchaser and seller; (2) a statement that the certificate is for a single purchase or is a blanket certificate covering future sales; (3) a statement of the basis for exemption, including the type of activity engaged in by the purchaser; (4) signature of an authorized person; and (5) the date of issuance. Penalties. Any purchaser who gives a Form 13 to a seller for any purchase which is other than for resale, lease, or rental in the normal course of the purchaser’s business, or is not otherwise exempted from sales and use tax under the Nebraska Revenue Act, is subject to a penalty of $100 or ten times the tax, whichever is greater, for each instance of presentation and misuse. In addition, any purchaser, or
their agent, who fraudulently signs a Form 13 may be found guilty of a Class IV misdemeanor. Categories of Exemption 1. Governmental agencies identified in Reg-1-012, Exemptions; Reg-1-072, United States Government and Federal Corporations; and Reg-1-093, Governmental Units. Governmental units are not assigned exemption numbers. Sales to the United States government, its agencies, instrumentalities, and corporations wholly owned by the U.S. government are exempt from sales tax. However, sales to institutions chartered or created under federal authority, but which are not directly operated and controlled by the United States government for the benefit of the public, generally are taxable. For construction projects for federal agencies, see Reg-1-017, Contractors. Purchases by governmental units that are not exempt from Nebraska sales and use taxes include, but are not limited to: governmental units of other states; sanitary and improvement districts; rural water districts; railroad transportation safety districts; and county historical or agricultural societies. 2. Purchases when the intended use renders it exempt as stated in paragraph 012.02D of Reg-1-012, Exemptions. See Nebraska Sales Tax Exemption Chart. Complete the description of the item purchased and the intended use on the front of Form 13. Beginning October 1, 2014, sales of repair and replacement parts for agricultural machinery and equipment used in commercial agriculture are exempt from sales and use taxes. When claiming this exemption, please enter “commercial agriculture” on the Intended Use of Items Purchased line. 3. Purchases made by organizations that have been issued a Nebraska Exempt Organization Certificate of Exemption. Reg-1-090, Nonprofit Organizations; Reg-1-091, Religious Organizations; and Reg-1-092, Educational Institutions, identify these organizations. These organizations are issued a Nebraska state exemption ID number. This exemption number must be entered in Section B of Form 13. Nonprofit health care organizations that hold a certificate of exemption are exempt for purchases of items for use at their facility, or portion of the facility, covered by the license issued under the Health Care Facility Licensure Act. Only specific types of health care facilities and activities are exempt. Purchases of items for use at facilities that are not covered under the license, or for any other activities that are not specifically exempt, are taxable. 4. Purchases of common or contract carrier motor vehicles, trailers, and semitrailers; accessories that physically become part of a common or contract carrier vehicle; and repair and replacement parts for these vehicles. The exemption number must be entered in Section B of the Form 13. 5. Purchases of manufacturing machinery and equipment made by a person engaged in the business of manufacturing, including repair and replacement parts or accessories, for use in manufacturing. 6. Occasional sales of used business or farm machinery or equipment productively used by the seller as a depreciable capital asset for more than one year in his or her business. The seller must have previously paid tax on the item being sold. The seller must complete, sign, and give the exemption certificate to the purchaser.
This section to be completed by a CVA employee. CVA Location: CVA Employee:
Individual Partnership Corporation LLC LLP
Select
Credit Application and Agreement
Agricultural Producer Non-Agricultural Patron
Account # ___________________________
All items MUST be fully completed and application MUST be signed before returning it to Central Valley Ag Full Legal Name: Current Address: City: State: Years/Months at above address: Previous Address (if less than 3 years at current address): City: State: Present Employer: Length of Employment:
Zip:
Zip:
SSN or FEIN: Date of Birth: Phone: ( ) Email address:
-
Years/Months at:
Annual Salary (excluding farming or ranching income):
(if seeking a joint account, include joint applicant's information on second page)
Financial Information: Current Financial Institutions for Loans and Deposits / Contact Person: 1. Account #: Address: 2. Account #: Address:
Phone: Phone:
Credit References: 1. 2.
Address: Address:
Phone: Phone:
List the maximum dollar amount to be purchased in any one month period under convenience credit. 1. Feed / Animal Health
$
4. Grain
$
2. Fertilizer / Chemical / Seed
$
5. Misc.
$
3. Propane / Fuels / Lubes
$
TOTAL
$ (Maximum per one month period)
Note to new Patrons: As a cooperative, Central Valley Ag classifies its patrons as stockholders if they are active agricultural producers or certificate of participation holders if they are non-agricultural patrons. When the Cooperative allocates patronage to new patrons the first time, it will deduct from the cash portion of the patronage ten dollars ($10) which will be used to pay for the face value of the share of common stock or the certification of participation. The remaining non-cash portion of any patronage allocation will be allocated on the books of the Cooperative as Members’ Equity Credits. The undersigned stockholder or patron of Central Valley Ag, York, Nebraska hereby gives consent that the amount of any distribution with respect to its patronage, which are made in qualified written notices of allocation (which means any capital stock, revolving funds, certificates, retain certificate, certificate of indebtedness, letter of advice, or other written notice; which discloses to the patron the stated dollar amount allocated to it and the portion thereof, in any, which constitutes a patronage dividend) and which are r eceived from the Central Valley Ag, York, Nebraska, will be taken into account by stockholder/patron at their stated dollar amounts in the manner provided in the Revenue Act of 1962 in the taxable year in which such wr itten notices of allocation are received by stockholder/patron. I, the undersigned, have read the Credit Agreement and agree to the terms of that agreement and the Consent To Account For Patronage.
I/We authorize Central Valley Ag to make whatever credit inquiries that it deems necessary in connection with this credit application or in the course of review of collection of any credit extended in reliance on the application. I/We authorize and instruct any person or consumer reporting agency to complete and furnish to Central Valley Ag any information it may have or obtain in response to such credit inquiries and agree that such information, along with this application, shall remain Central Valley Ag’s property whether or not credit is extended. I/We further understand that all authorized charges to my/our account are my/our obligations, regardless of personal agreements with other parties, renter or tenants of our land or dwellings, unless they have applied for, received and used their own account for acquiring goods and services. All information set forth in this application is declared to be a true representation to the facts, made for the purpose of obtaining the credit requested and any willful misrepresentation on this application could result in criminal action. Notice: The Federal Equal Credit Opportunity Act prohibits creditors from discrimination against credit applications on the basis of sex or marital status. The Federal agency which compliance with this law concerning this cooperative is: Federal Trade Commission, Denver Regional Office 1405 Curtis Street, Suite 2900 Denver, CO 80202 IF THE CUSTOMER IS A CORPORATION OR OTHER ENTITY, THE PERSON EXECUTING THIS AGREEMENT AGREES TO PERSONALLY GUARANTEE THE PAYMENT OF ALL AMOUNTS DUE FROM THE CUSTOMER TO CENTRAL VALLEY AG. CENTRAL VALLEY AG MAY ALSO REQUIRE A PERSONAL GUARNTEE FROM OTHER INDIVIDUALS AS A CONDITION FOR RECEIVING CREDIT. THE CREDIT AGREEMENT OF CENTRAL VALLEY AG IS INCORPORATED INTO AND A PART OF THIS CREDIT APPLICATION AND AGREEMENT. I/WE ACKNOWLEDGE RECEIPT OF THE CREDIT AGREEMENT OF CENTRAL VALLEY AG AND AGREE TO BE BOUND BY ITS TERMS AND CONDITIONS. I/WE FURTHER ACKNOWLEDGE RECEIPT OF THE REQUIRED FRDERAL DISCLOSURES. I/WE GIVE CENTRAL VALLEY AG PERMISSION TO CONFIRM FINANCING ARRANGEMENTS MADE WITH THE ABOVE LENDING INSTITUTIONS.
Applicant’s Signature: __________________________________________________________________________________
Date: ________________________
Joint Applicant or Guardian: ___________________________________________________________________
Date: _____________________________
Revised: 6/15/2015
Account # __________________________
Joint Applicant Information: (complete ONLY if seeking a joint account and using joint applicant's income for credit consideration) Full Legal Name: Current Address: City: State: Years/Months at above address: Previous Address (if less than 3 years at current address): City: State: Present Employer: Length of Employment:
Zip:
Zip:
SSN or FEIN: Date of Birth: Phone: ( ) Email address:
-
Years/Months at:
Annual Salary (excluding farming or ranching income):
Revised: 6/15/2015
CENTRAL VALLEY AG
Credit Agreement Central Valley Ag, herein after referred to as the “Co-op” offers convenience credit to qualified patrons. Convenience credit should not be construed as a line of credit for long term financing. Patrons using convenience credit must follow the terms of this Credit Agreement and associated policies, applications, agreements, guarantees or forms in order to remain eligible for convenience credit. The Co-op considers the extension of convenience credit as a service to the patrons and not as a right. The Co-op reserves the right to deny or limit the extension of credit to any patron when such denial or limit is in the best interest of the Co-op. Every patron who does business with the Co-op shall be deemed to have agreed to be bound by the provisions of this Credit Agreement. The Credit Agreement of the Co-op is subject to change without prior notice. Upon approval of credit for the Customer, the Co-op will allow the Customer to make purchases of products and services on credit and Customer agrees to pay for the products in accordance with this Agreement. DUE DATE
All purchases on credit will be stated on the monthly invoice statement rendered by the Co-op as of the last business day of the month. The statements are due and payable by the 20th of the month following statement.
DELINQUENCY CHARGE AND INTEREST CHARGE
Any unpaid invoice statement balance or portion thereof not paid by the DUE DATE will be subject to a DELINQUENCY CHARGE of 5% which will be added to the invoice balance. In addition to the Delinquency Charge, an INTEREST CHARGE of 1.33% per month will be assessed on the last day of the month following the statement date on all unpaid balances existing as of that date.
TERMINATION OF CREDIT
The Co-op reserves the right to terminate credit sales at any time without prior notification. No amount of additional sales of products on credit will be allowed if the account has a past due balance more than 45 days following the statement date.
CHANGE IN TERMS
Credit terms may be changed at the discretion of the Co-op including, but not limited to, changing the due date, changing the billing cycle, LIMITING THE AMOUNT OF APPROVED CREDIT, or on any other matter after notice of such change has been given to the Customer.
DISPUTED STATEMENT
All invoices and statements rendered by the Co-op will be conclusive as to the items purchased and charges therefor unless the Customer informs the Co-op in writing of a dispute thereon within 10 days of the statement date.
GUARANTY
If the Customer is a corporation or other entity, the person executing this Agreement, in order to induce the Co-op to grant Credit to the corporation or other entity, hereby agrees to personally guarantee the payment of all amounts due from the Customer to the Co-op. The Cooperative may further require separate personal guarantees from other stockholders, members, partners, whomsoever, in granting credit to a corporation or other entity.
NO WAIVER RIGHTS
Neither an extension of time for payment granted to the Customer, if any, nor acceptance of partial payment by the Co-op, if any, shall constitute a waiver of any right to full payment of all sums due and owing to the Co-op by the Customer.
RIGHT OF OFFSET
Customer agrees that the Co-op may offset and apply any amounts it may from time to time owe the Customer for whatever reason against any unpaid past due credit balance of the Customer.
ADMINISTRATIVE CHARGES
The Co-op may assess a reasonable charge to offset the additional administrative costs incurred by the Co-op when a Customer pays all or a portion of his or her convenience credit account balance by credit card. Such charges shall be added to the Customer’s convenience credit balance prior to completing the credit card payment transaction.
DISPUTE RESOLUTION
This Credit Agreement, including any action to collect past due balances, enforce personal guarantees or litigate product claims for products purchased on credit may be enforced in any Court of competent jurisdiction in the State of Nebraska. Applicant, guarantor and Co-op, to the fullest extent possible waive any claim that the forum is not convenient. Applicant, guarantor and Co-op further, to the fullest extent allowed by law waive their right to a trial by jury.
Applicant agrees that the Co-op may establish other credit terms, require security and participate in shared financing arrangements as it deems necessary in its sole discretion. Adopted by the Board of Directors of Central Valley Ag Cooperative on July 1, 2014.
Applicant’s Signature: ____________________________________________________________________ Date: _____________________
Joint Applicant or Guardian: ________________________________________________________________ Date: _____________________
Revised: 6/15/2015
RESET FORM
PRINT FORM
Nebraska Resale or Exempt Sale Certificate
Form
for Sales Tax Exemption
Name and Mailing Address of Purchaser
Name and Mailing Address of Seller
Name
13
Name
Central Valley Ag Cooperative Legal Name Street Address (Do not use PO Box)
Street or Other Mailing Address
PO Box 429 City
State
Zip Code
City
State
NE
York
Zip Code
68467
Check Type of Certificate
c Single Purchase
If single purchase is checked, enter the related invoice or purchase order number ______________________________________.
c Blanket
If blanket is checked, this certificate is valid until revoked in writing by the purchaser.
I hereby certify that the purchase, lease, or rental by the above purchaser is exempt from the Nebraska sales tax for the following reason:
Check One
c Purchase for Resale (Complete Section A.)
c Exempt Purchase (Complete Section B.)
c Contractor (Complete Section C.)
Section A — Nebraska Resale Certificate
Description of Property or Service Purchased
I hereby certify that the purchase, lease, or rental of ________________________________________________________________from the seller listed above is exempt from the Nebraska sales tax as a purchase for resale, rental, or lease in the normal course of our business. The property or service will be resold either in the form or condition in which it was purchased, or as an ingredient or component part of other property or service to be resold. I further certify that we are engaged in business as a: c Wholesaler c Retailer c Manufacturer c Lessor of Description of Product or Service Sold, Leased, or Rented ___________________________________________________________________________________________________________________. My Nebraska Sales Tax Permit Number is 01-_________________________________. If none, state the reason _____________________________________________________________________________________________________, or Foreign State Sales Tax Number__________________________________________ State __________________________________________.
Section B — Nebraska Exempt Sale Certificate The basis for this exemption is exemption category ______ (insert appropriate number for the category of exemption described on the reverse side). If exemption category 2 or 5 is claimed, enter the following information: Description of Items Purchased
Intended Use of Items Purchased
_________________________________________________________________________________________________________________________. If exemption category 3 or 4 is claimed, enter your Nebraska Exemption Certificate number. 05 -______________________________ Do not enter your Federal Employer ID Number.
If exemption category 6 is claimed, the seller must enter the following information and sign this form below: Description of Items Sold
Date of Seller’s Original Purchase
Was tax paid when purchased by seller?
c Yes
c No
Was item depreciable?
c Yes
c No
Section C — For Contractors Only 1. Purchase of building materials or fixtures.
c As an Option 1 or Option 3 contractor, I hereby certify that the purchase of building materials and fixtures from the seller listed above are exempt from Nebraska sales tax. My Nebraska Sales or Use Tax Permit Number is: _____________________________________________________.
2. Purchases made by an Option 2 contractor under a Purchasing Agent Appointment on behalf of_________________________ (exempt entity) ________________________________________. As an Option 2 contractor, I hereby certify that the purchase of building materials and fixtures from the seller listed above is exempt from Nebraska sales tax pursuant to the attached Purchasing Agent Appointment and Delegation of Authority for Sales and Use Tax, Form 17. Any purchaser, agent, or other person who completes this certificate for any purchase which is not for resale, lease, or rental in the regular course of the purchaser’s business, or is not otherwise exempted from sales and use taxes is subject to a penalty of $100 or ten times the tax, whichever amount is larger, for each instance of presentation and misuse. With regard to a blanket certificate, this penalty applies to each purchase made during the period the blanket certificate is in effect. Under penalties of law, I declare that I am authorized to sign this certificate, and to the best of my knowledge and belief, it is correct and complete.
sign here
Authorized Signature
Title
Date
Authorized Signature Name (please print)
Do not send this certificate to the Nebraska Department of Revenue. Keep it as part of your records. Sellers cannot accept incomplete certificates. 6-134-1970 Rev. 10-2014 revenue.nebraska.gov, 800-742-7474 (NE and IA), 402-471-5729 Supersedes 6-134-1970 Rev. 3-2009
Instructions
Who May Issue a Resale Certificate. Form 13, Section A, is issued by persons or organizations making purchases of property or taxable services that will subsequently be resold in the purchaser’s normal course of business. The property or services must be resold in the same form or condition as when purchased, or as an ingredient or component part of other property that will be resold. Who May Issue an Exempt Sale Certificate. Form 13, Section B, may only be issued by governmental units and persons or organizations that are exempt from paying Nebraska sales and use tax. Nonprofit organizations that are exempt from paying sales and use tax are listed in the Nebraska Sales Tax Exemption Chart.
Enter the appropriate number from the “Categories of Exemption” in the space provided that properly reflects the basis for your exemption. If category 2 through 6 is the basis for exemption, you must complete the information requested in Section B. For additional information about proper issuance and use of this certificate, please review Reg-1-013, Sale for Resale – Resale Certificate, and Reg-1-014, Exempt Sale Certificate. Contractors. To make tax-exempt purchases of building materials and fixtures, Option 1 or Option 3 contractors must complete Form 13, Section C, Part 1. To make tax-exempt purchases of building materials and fixtures pursuant to a construction project for an exempt governmental unit or an exempt nonprofit organization, Option 2 contractors must complete Form 13, Section C, Part 2. The contractor must also attach a copy of a properly completed Purchasing Agent Appointment and Delegation of Authority for Sales and Use Tax, Form 17, to the Form 13, and both documents must be given to the supplier when purchasing building materials. See the contractor information guides for additional information. When and Where to Issue. The Form 13 must be given to the seller at the time of the purchase to document why sales tax does not apply to the purchase. The Form 13 must be kept with the seller’s records for audit purposes (see Reg-1-012, Exemptions). Do not send Forms 13 to the Nebraska Department of Revenue. Sales Tax Number. A purchaser who is engaged in business as a wholesaler or manufacturer is not required to provide an ID number when completing Section A. Out-of-state purchasers may provide their home state sales tax number. Section B does not require a Nebraska ID number when exemption category 1, 2, or 5 is indicated. Fully Completed Resale or Exempt Sale Certificate. For a resale certificate to be fully completed, it must include: (1) identification of the purchaser and seller, type of business engaged in by the purchaser, and reason for the exemption; (2) sales tax permit number; (3) signature of an authorized person; and (4) the date of issuance. For an exempt sale certificate to be fully completed, it must include: (1) identification of purchaser and seller; (2) a statement that the certificate is for a single purchase or is a blanket certificate covering future sales; (3) a statement of the basis for exemption, including the type of activity engaged in by the purchaser; (4) signature of an authorized person; and (5) the date of issuance. Penalties. Any purchaser who gives a Form 13 to a seller for any purchase which is other than for resale, lease, or rental in the normal course of the purchaser’s business, or is not otherwise exempted from sales and use tax under the Nebraska Revenue Act, is subject to a penalty of $100 or ten times the tax, whichever is greater, for each instance of presentation and misuse. In addition, any purchaser, or
their agent, who fraudulently signs a Form 13 may be found guilty of a Class IV misdemeanor. Categories of Exemption 1. Governmental agencies identified in Reg-1-012, Exemptions; Reg-1-072, United States Government and Federal Corporations; and Reg-1-093, Governmental Units. Governmental units are not assigned exemption numbers. Sales to the United States government, its agencies, instrumentalities, and corporations wholly owned by the U.S. government are exempt from sales tax. However, sales to institutions chartered or created under federal authority, but which are not directly operated and controlled by the United States government for the benefit of the public, generally are taxable. For construction projects for federal agencies, see Reg-1-017, Contractors. Purchases by governmental units that are not exempt from Nebraska sales and use taxes include, but are not limited to: governmental units of other states; sanitary and improvement districts; rural water districts; railroad transportation safety districts; and county historical or agricultural societies. 2. Purchases when the intended use renders it exempt as stated in paragraph 012.02D of Reg-1-012, Exemptions. See Nebraska Sales Tax Exemption Chart. Complete the description of the item purchased and the intended use on the front of Form 13. Beginning October 1, 2014, sales of repair and replacement parts for agricultural machinery and equipment used in commercial agriculture are exempt from sales and use taxes. When claiming this exemption, please enter “commercial agriculture” on the Intended Use of Items Purchased line. 3. Purchases made by organizations that have been issued a Nebraska Exempt Organization Certificate of Exemption. Reg-1-090, Nonprofit Organizations; Reg-1-091, Religious Organizations; and Reg-1-092, Educational Institutions, identify these organizations. These organizations are issued a Nebraska state exemption ID number. This exemption number must be entered in Section B of Form 13. Nonprofit health care organizations that hold a certificate of exemption are exempt for purchases of items for use at their facility, or portion of the facility, covered by the license issued under the Health Care Facility Licensure Act. Only specific types of health care facilities and activities are exempt. Purchases of items for use at facilities that are not covered under the license, or for any other activities that are not specifically exempt, are taxable. 4. Purchases of common or contract carrier motor vehicles, trailers, and semitrailers; accessories that physically become part of a common or contract carrier vehicle; and repair and replacement parts for these vehicles. The exemption number must be entered in Section B of the Form 13. 5. Purchases of manufacturing machinery and equipment made by a person engaged in the business of manufacturing, including repair and replacement parts or accessories, for use in manufacturing. 6. Occasional sales of used business or farm machinery or equipment productively used by the seller as a depreciable capital asset for more than one year in his or her business. The seller must have previously paid tax on the item being sold. The seller must complete, sign, and give the exemption certificate to the purchaser.
