Credit Application & Agreement Check One Select
Check One
This section to be completed by a CVA employee. CVA Location: CVA Employee:
Individual/Sole Proprietor Partnership Corporation LLC LLP
Select
Credit Application & Agreement
Agricultural Producer Non-Agricultural Patron
Account # ___________________________
Completed Credit Application MUST be Signed and Accompanied by a Copy of Applicant’s State Driver’s License Primary Applicant Information Full Legal Name (as shown on State Driver’s License): Business Name (if applicable): 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: ( )
-
Years/Months at:
Annual Salary (excluding farming or ranching income):
(if seeking a joint account, include joint applicant's information on second page)
Financial Institutions for Loans and Deposits 1. 2.
Contact Person: Contact Person:
Address: 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 received 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 written 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: 1/27/2017
Account # __________________________
Co-Applicant Information: (complete ONLY if seeking a joint account and using joint applicant's income for credit consideration) Full Legal Name (as shown on State Driver’s License): 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: ( )
-
Years/Months at:
Annual Salary (excluding farming or ranching income):
Revised: 1/27/2017
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: 1/27/2017
W-9
Form (Rev. November 2017) Department of the Treasury Internal Revenue Service
Request for Taxpayer Identification Number and Certification ▶
Give Form to the requester. Do not send to the IRS.
Go to www.irs.gov/FormW9 for instructions and the latest information.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
Print or type. See Specific Instructions on page 3.
2 Business name/disregarded entity name, if different from above 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes. Individual/sole proprietor or single-member LLC
C Corporation
S Corporation
Partnership
Trust/estate Exempt payee code (if any)
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ▶ Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code (if any) another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. Other (see instructions) ▶ 5 Address (number, street, and apt. or suite no.) See instructions.
(Applies to accounts maintained outside the U.S.)
Requester’s name and address (optional)
6 City, state, and ZIP code 7 List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.
Part II
Social security number
–
–
or Employer identification number
–
Certification
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign Here
Signature of U.S. person ▶
Date ▶
General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.
Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) Cat. No. 10231X
• Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Form W-9 (Rev. 11-2017)
KANSAS DEPARTMENT OF REVENUE AGRICULTURAL EXEMPTION CERTIFICATE The undersigned purchaser certifies that the tangible personal property or service purchased from: Seller:
Central Valley Ag Cooperative __________________________________________________________________________________________________ Business Name
Box 429, York, NE 68467 Address: PO __________________________________________________________________________________________________ Street, RR, or P. O. Box
City
State
Zip + 4
is exempt from Kansas sales and compensating use tax for the following reason:
Ingredient or component part
Consumed in production
Propane for agricultural use
The property purchased is farm or aquaculture machinery or equipment, repair or replacement parts, or labor services on farm or aquaculture machinery or equipment which will be used exclusively in farming, ranching, or aquaculture.
Seeds and tree seedlings; fertilizers, insecticides, herbicides, germicides, pesticides, fungicides; and services, purchased and used for the purpose of producing plants in order to prevent soil erosion on land devoted to agricultural use. Fertilizer/Chemicals/Seed/Feed Description of tangible personal property or services purchased: _______________________________________
Equipment Rental/Machinery Repair _________________________________________________________________________________________ The undersigned understands and agrees that if the tangible personal property or services are used other than as stated above or for any other purpose that is not exempt from sales or compensating tax, the undersigned purchaser becomes liable for the tax. Purchaser: _________________________________________________________________________________________________ Business Name
Address: __________________________________________________________________________________________________ Street, RR, or P. O. Box
City
State
Zip + 4
Authorized Signature: ____________________________________________________________ Date: _____________________
THIS CERTIFICATE MUST BE COMPLETED IN ITS ENTIRETY. WHO MAY USE THIS CERTIFICATE? Farmers, ranchers, feedlots, fisheries, grass farms, nurseries, Christmas tree farms, custom cutters, crop dusters, and others engaged in farming, ranching, aquaculture, or farm and ranch work for hire are entitled to this exemption. WHAT PURCHASES ARE EXEMPT? This certificate contains five separate exemptions. Examples of items or uses that are exempt, and those that are taxable are given for each exemption. In addition to meeting the definition for an “ingredient or component part” or the “consumed in production” exemption, items purchased with this certificate must be used exclusively in agriculture or aquaculture to produce a product for resale — food, fiber, fur, or offspring for such purposes. RETAINING THIS CERTIFICATE: Sellers should retain a completed copy of this certificate in their records for at least three years from the date of sale. A seller is relieved of liability for the tax if it obtains a completed exemption certificate from a purchaser with which the seller has a recurring business relationship. A certificate need not be renewed or updated when there is a recurring business relationship between the buyer and seller. A recurring business relationship exists when a period of no more than 12 months elapses between sales transactions. INGREDIENT OR COMPONENT PART: EXEMPT: Wheat, corn, milo, soybean, and sunflower seed used to produce these crops; feed for beef or dairy cattle, sheep and hogs, ground grain for chickens in a poultry or egg-laying operation; food for aquatic plants and animals (fish); baler twine, baler wire and bale wrap used on hay that will be resold or used in the farmer or rancher’s own livestock production operation. TAXABLE: Bedding plants and seeds for a home garden; or food for pets and pleasure animals. CONSUMED IN PRODUCTION: EXEMPT: Insecticides, herbicides, fungicides, fumigants, germicides, pesticides, and other such chemicals used on growing agricultural crops for resale or used in the processing or storage of fruit, vegetables, feeds, seeds, and grains; antibiotics, biologicals, pharmaceuticals, vitamins, minerals, and like products which are fed, injected, or otherwise applied to livestock for resale; off-road diesel fuel, oil, and oil additives consumed by farm tractors and combines; LP gas for agricultural use. TAXABLE: Insecticides and the like purchased for use in a home garden; antibiotics, vitamins, etc. purchased for pets or pleasure animals; fuels, oils, for cars, trucks, and ATVs. PROPANE FOR AGRICULTURAL USE: EXEMPT: Propane used to operate farm machinery. TAXABLE: Propane for non-agricultural use, including for barbecue grills, campers, RV equipment and vehicles licensed to operate on public highways. FARM OR AQUACULTURE MACHINERY AND EQUIPMENT: To qualify, the machinery or equipment must be used ONLY in farming, ranching, the operation of the feedlot or nursery, farm or ranch work for hire, or aquaculture. The exemption applies to the rental or purchase of farm or aquaculture machinery and equipment, as well as the parts and labor purchased to repair or maintain the farm or aquaculture machinery and equipment. EXEMPT: Combines, discs, farm tractors, harrows, hay balers, irrigation and milking equipment, planters, plows, tillers, and work-site utility vehicles (see NOTICE 06-02). TAXABLE: Air compressors and tanks, all terrain vehicles (ATVs), automobiles and trucks, barn ventilators, building and electrical materials, bulldozers, fencing materials and tools, garden hoses, grain bins, hand tools, lawnmowers, silos, water and gas wells, welding equipment, and any equipment that becomes a part of a building, facility, or land improvement. SEEDS AND TREE SEEDLINGS: All components of a shelter belt or wind break planted on agricultural land are exempt from sales tax. This includes the trees, fertilizers, pest control chemicals, moisture/weed barrier and staples, and above ground irrigation equipment. Furthermore, all services related to the planting or caring of the trees planted on agricultural land are exempt from sales tax. Note: See Publication KS-1550, Kansas Sales & Use Tax for the Agricultural Industry, at www.ksrevenue.org for additional information. ST-28F (Rev. 8/14)
This section to be completed by a CVA employee. CVA Location: CVA Employee:
Individual/Sole Proprietor Partnership Corporation LLC LLP
Select
Credit Application & Agreement
Agricultural Producer Non-Agricultural Patron
Account # ___________________________
Completed Credit Application MUST be Signed and Accompanied by a Copy of Applicant’s State Driver’s License Primary Applicant Information Full Legal Name (as shown on State Driver’s License): Business Name (if applicable): 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: ( )
-
Years/Months at:
Annual Salary (excluding farming or ranching income):
(if seeking a joint account, include joint applicant's information on second page)
Financial Institutions for Loans and Deposits 1. 2.
Contact Person: Contact Person:
Address: 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 received 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 written 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: 1/27/2017
Account # __________________________
Co-Applicant Information: (complete ONLY if seeking a joint account and using joint applicant's income for credit consideration) Full Legal Name (as shown on State Driver’s License): 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: ( )
-
Years/Months at:
Annual Salary (excluding farming or ranching income):
Revised: 1/27/2017
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: 1/27/2017
W-9
Form (Rev. November 2017) Department of the Treasury Internal Revenue Service
Request for Taxpayer Identification Number and Certification ▶
Give Form to the requester. Do not send to the IRS.
Go to www.irs.gov/FormW9 for instructions and the latest information.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
Print or type. See Specific Instructions on page 3.
2 Business name/disregarded entity name, if different from above 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):
3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes. Individual/sole proprietor or single-member LLC
C Corporation
S Corporation
Partnership
Trust/estate Exempt payee code (if any)
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ▶ Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code (if any) another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. Other (see instructions) ▶ 5 Address (number, street, and apt. or suite no.) See instructions.
(Applies to accounts maintained outside the U.S.)
Requester’s name and address (optional)
6 City, state, and ZIP code 7 List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.
Part II
Social security number
–
–
or Employer identification number
–
Certification
Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Sign Here
Signature of U.S. person ▶
Date ▶
General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.
Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) Cat. No. 10231X
• Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Form W-9 (Rev. 11-2017)
KANSAS DEPARTMENT OF REVENUE AGRICULTURAL EXEMPTION CERTIFICATE The undersigned purchaser certifies that the tangible personal property or service purchased from: Seller:
Central Valley Ag Cooperative __________________________________________________________________________________________________ Business Name
Box 429, York, NE 68467 Address: PO __________________________________________________________________________________________________ Street, RR, or P. O. Box
City
State
Zip + 4
is exempt from Kansas sales and compensating use tax for the following reason:
Ingredient or component part
Consumed in production
Propane for agricultural use
The property purchased is farm or aquaculture machinery or equipment, repair or replacement parts, or labor services on farm or aquaculture machinery or equipment which will be used exclusively in farming, ranching, or aquaculture.
Seeds and tree seedlings; fertilizers, insecticides, herbicides, germicides, pesticides, fungicides; and services, purchased and used for the purpose of producing plants in order to prevent soil erosion on land devoted to agricultural use. Fertilizer/Chemicals/Seed/Feed Description of tangible personal property or services purchased: _______________________________________
Equipment Rental/Machinery Repair _________________________________________________________________________________________ The undersigned understands and agrees that if the tangible personal property or services are used other than as stated above or for any other purpose that is not exempt from sales or compensating tax, the undersigned purchaser becomes liable for the tax. Purchaser: _________________________________________________________________________________________________ Business Name
Address: __________________________________________________________________________________________________ Street, RR, or P. O. Box
City
State
Zip + 4
Authorized Signature: ____________________________________________________________ Date: _____________________
THIS CERTIFICATE MUST BE COMPLETED IN ITS ENTIRETY. WHO MAY USE THIS CERTIFICATE? Farmers, ranchers, feedlots, fisheries, grass farms, nurseries, Christmas tree farms, custom cutters, crop dusters, and others engaged in farming, ranching, aquaculture, or farm and ranch work for hire are entitled to this exemption. WHAT PURCHASES ARE EXEMPT? This certificate contains five separate exemptions. Examples of items or uses that are exempt, and those that are taxable are given for each exemption. In addition to meeting the definition for an “ingredient or component part” or the “consumed in production” exemption, items purchased with this certificate must be used exclusively in agriculture or aquaculture to produce a product for resale — food, fiber, fur, or offspring for such purposes. RETAINING THIS CERTIFICATE: Sellers should retain a completed copy of this certificate in their records for at least three years from the date of sale. A seller is relieved of liability for the tax if it obtains a completed exemption certificate from a purchaser with which the seller has a recurring business relationship. A certificate need not be renewed or updated when there is a recurring business relationship between the buyer and seller. A recurring business relationship exists when a period of no more than 12 months elapses between sales transactions. INGREDIENT OR COMPONENT PART: EXEMPT: Wheat, corn, milo, soybean, and sunflower seed used to produce these crops; feed for beef or dairy cattle, sheep and hogs, ground grain for chickens in a poultry or egg-laying operation; food for aquatic plants and animals (fish); baler twine, baler wire and bale wrap used on hay that will be resold or used in the farmer or rancher’s own livestock production operation. TAXABLE: Bedding plants and seeds for a home garden; or food for pets and pleasure animals. CONSUMED IN PRODUCTION: EXEMPT: Insecticides, herbicides, fungicides, fumigants, germicides, pesticides, and other such chemicals used on growing agricultural crops for resale or used in the processing or storage of fruit, vegetables, feeds, seeds, and grains; antibiotics, biologicals, pharmaceuticals, vitamins, minerals, and like products which are fed, injected, or otherwise applied to livestock for resale; off-road diesel fuel, oil, and oil additives consumed by farm tractors and combines; LP gas for agricultural use. TAXABLE: Insecticides and the like purchased for use in a home garden; antibiotics, vitamins, etc. purchased for pets or pleasure animals; fuels, oils, for cars, trucks, and ATVs. PROPANE FOR AGRICULTURAL USE: EXEMPT: Propane used to operate farm machinery. TAXABLE: Propane for non-agricultural use, including for barbecue grills, campers, RV equipment and vehicles licensed to operate on public highways. FARM OR AQUACULTURE MACHINERY AND EQUIPMENT: To qualify, the machinery or equipment must be used ONLY in farming, ranching, the operation of the feedlot or nursery, farm or ranch work for hire, or aquaculture. The exemption applies to the rental or purchase of farm or aquaculture machinery and equipment, as well as the parts and labor purchased to repair or maintain the farm or aquaculture machinery and equipment. EXEMPT: Combines, discs, farm tractors, harrows, hay balers, irrigation and milking equipment, planters, plows, tillers, and work-site utility vehicles (see NOTICE 06-02). TAXABLE: Air compressors and tanks, all terrain vehicles (ATVs), automobiles and trucks, barn ventilators, building and electrical materials, bulldozers, fencing materials and tools, garden hoses, grain bins, hand tools, lawnmowers, silos, water and gas wells, welding equipment, and any equipment that becomes a part of a building, facility, or land improvement. SEEDS AND TREE SEEDLINGS: All components of a shelter belt or wind break planted on agricultural land are exempt from sales tax. This includes the trees, fertilizers, pest control chemicals, moisture/weed barrier and staples, and above ground irrigation equipment. Furthermore, all services related to the planting or caring of the trees planted on agricultural land are exempt from sales tax. Note: See Publication KS-1550, Kansas Sales & Use Tax for the Agricultural Industry, at www.ksrevenue.org for additional information. ST-28F (Rev. 8/14)
