CREDIT APPLICATION YES NO
P O BOX 128, 228 S MAIN KENSINGTON, KS 66951 785-476-2211 FAX 785-476-2223
Kensington • Agra • Kirwin • Glade
CREDIT APPLICATION
ACCT #
CONTACT INFO/OWNERSHIP NAME
DL# SOCIAL SECURITY #
ADDRESS
CITY
STATE
ZIP
PHONE # REQUESTED $$$ AMOUNT
EMAIL
CURRENT EMPLOYER
GAS CARD REQUESTED
ADDRESS
YES
THE UNDERSIGNED IS_____/IS NOT______ A PRODUCER OF AG PRODUCTS (COMMOM STOCK REQUIRES APPLICANT TO BE A PRODUCER OF AG PRODUCTS)
BUSINESS FINANCE INFO BANK NAME
BRANCH
BANK ADDRESS
PHONE
FAX
TRADE/CREDIT REFERENCES (UTILITIY COMPANIES, CREDIT CARD REF, ANY PLACE YOU DO BUSINESS) COMPANY NAME
PHONE
FAX
ADDRESS
CITY,STATE,ZIP
CONTACT
EMAIL
COMPANY NAME
PHONE
ADDRESS
CITY,STATE,ZIP
CONTACT
EMAIL
FAX
UNDER THE PENALITES OF PERJURY, I CERTIFY THAT THE INFORMATION PROVIDED ON THIS FORM IS TRUE, CORRECT AND COMPLETE AND THAT WE ARE NOT SUBJECT TO BACKUP WITHHOLDING PURSUANT TO INTERNAL REVENUE CODE SECTION 3406(d). WE CERTIFY THAT ALL THE INFORMATION ON THIS FORM IS CORRECT. WE FULLY UNDERSTAND YOUR CREDIT TERMS AND AGREE TO THE PROPER PAYMENT IN CONSIDERATION OF EXTENDED CREDIT. BY SUBMITTING THIS APPLICATION YOU AUTHORIZE PRO AG MARKETING TO MAKE INQUIRIES INTO THE BANKING & TRADE REFERENCES YOU HAVE SUPPLIED.
AUTHORIZED SIGNATURE(OWNER, OFFICER, OR PRINCIPAL)
TITLE
DATE
NO
CHARGE ACCOUNT AGREEMENT THIS AGREEMENT, MADE AND ENTERED ON THE ABOVE STATED DATE BY THE SAID CREDIT PATRON AND THE COOPERATIVE ASSOCIATION (NAMED ABOVE), PURSUANT TO THE CONSUMER CREDIT PROTECTION ACT (FEDERAL TRUTH IN LENDING ACT (FEDERAL TRUTH IN LENDING ACT, PUBLIC LAW 90-321; 82 STAT. 146) AND THE KANSAS UNIFORM CONSUMER CREDIT CODE (K.S.A. 16(a) 1-101 et seq). THE COOPERATIVE ASSOCIATION AGREES, IF THIS AGREEMENT IS APPROVED BY THE ASSOCIATION, THAT IT SHALL ALLOW THE CREDIT PATRON TO PURCHASE GOOD AND SERVICES ON CREDIT AND THE CREDIT PATRON AGREES TO PAY FOR ANY GOODS AND SERVICES IN ACCORDANCE WITH THIS AGREEMENT. •
ALL PURCHASE(S) MADE ON CREDIT DURING THE MONTH THAT ARE REFLECTED ON THE PERIODIC BILLING STMT FOR SUCH MONTH ARE DUE AND PAYABLE BY THE 15TH OF THE MONTH FOLLOWING PURCHASE
•
IF ALL PURCHASES ARE PAID IN FULL BEFORE THE 15TH DAY OF THE MONTH FOLLOWING THE MONTH OF PURCHASE, THE ACCOUNT SHALL NOT BE SUBJECT TO FINANCE CHARGE
•
ANY BALANCE NOT PAID BEFORE THE 15TH DAY OF THE MONTH FOLLOWING THE MONTH OF PURCHASE, SHALL BE SUBJECT TO A FINANCE CHARGE OF 1.2% PER MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 14.4%, SAID F/C TO APPLY TO THE UNPAID BALANCE ON THE ACCOUNT ON THE LAST DAY OF BILLING CYCLE CARRIED OVER FROM THE PRIOR MONTH, AND THE MINIMUM AMOUNT OF SUCH CHARGE SHALL BE $.50 PER MONTH
•
THE COOPERATIVE RESERVES THE RIGHT TO TERMINATE CREDIT SALES TO PATRON AT ANY TIME WITHOUT PRIOR NOTIFICATION, AND IN ADDITION THERETO, NO ADDITIONAL CREDIT PURCHASES WILL BE ALLOWED TO ANY ACCOUNT THAT IS OVER 30 DAYS PAST DUE.
•
THIS AGREEMENT MAY BE CHANGED BY THE COOPERATIVE ASSOCIATION TO INCREASE THE FINANCE CHARGE, CHANGE THE DUE DATE, CHANGE THE BILLING CYCLE, CHANGE THE METHOD OF CALCULATING THE FINANCE CHARGE OR CHANGE MATTERS OF SIMILAR NATURE WITHIN THE LIMITATIONS OF APPLICABLE LAW. NOTICE OF ANY SUCH CHANGE SHALL BE GIVEN TO THE PATRON 30 DAYS PRIOR TO THE EFFECTIVE DATE OF CHANGE.
•
ANY PURCHASE(S) MADE PURSUANT TO THIS AGREEMENT SHALL BE SECURED BY A SECURITY INTEREST AND LIEN IN ANY INVESTMENT THE PATRON MAY HAVE IN THE COOPERATIVE ASSOCIATION. INVESTMENT MEANS ANY CERTIFICATES OF INDEBTEDNESS, NOTE, STOCK, OR STOCK CREDIT, OR REVOLVING FUND CREDIT OR PATRONAGE LEDGER CREDIT. THE PATRON DOES NOT HAVE THE RIGHT TO DEMAND OFFSET OF SUCH INVESTMENT ON HIS/HER ACCOUNT. SUCH AN OFFSET MAY BE MADE ONLY AT THE DISCRETION OF THE BOARD OF DIRECTORS OF THIS ASSOCIATION.
•
CREDIT PATRON AGREES TO PAY THE REASONABLE COSTS OF COLLECTION INCLUDING, BUT NOT LIMITED TO, ATTORNEY AND COLLECTION AGENCY FEES(BUT NOT BOTH), AND THE COURT COSTS, BUT SUCH FEES MAY NOT EXCEED 15% OF THE UNPAID DEBT AFTER DEFAULT, IN ACCORDANCE WITH KSA 16a-2-507 OR AS HEREAFTER AMENDED.
•
UNTIL NOTIFIED IN WRITING TO THE CONTRARY BY THE PATRON, THE COOPERATIVE ASSOCIATION MAY ASSUME THAT THE PATRON'S SPOUSE, CHILDREN OVER THE AGE OF SIXTEEN YEARS, AND EMPLOYEES, IF ANY AUTHORIZED TO PURCHASE GOODS OR SERVICES AND CHARGE THEM TO THE PATRON'S ACCOUNT
PERSONAL GUARANTEE WE (OR I) , the undersigned do hereby jointly, severally and personally guarantee the above purchasers full performance of said purchase agreement and hereby agree to indemnify Pro-Ag Marketing against any and all damages, loss expense (including attorney's fees) and/or liability sustained by Pro-Ag Marketing of Kensington, KS , by reason of or related to, the above purchaser's failure to perform or to pay when due, charges incurred in accordance with the above agreement. Pro Ag Marketing of Kensington, KS may enforce this agreement against the undersigned or any of them, jointly or severally whether or not any action is ever taken by it against the above purchaser.
GUARANTOR'S SIGNATURE (OWNER, OFFICER OR PRINCIPAL LISTED ABOVE)
TITLE
DATE
NAME (SPOUSE)
TITLE
DATE
** THIS APPLICATION WILL NOT BE PROCESSED WITHOUT A GARANTOR'S SIGNATURE, SS#, DL# AND TITLE
OFFICE USE: APPROVED FOR CREDIT BY REFERENCE RESULTS
DATE:
Kensington • Agra • Kirwin • Glade
CREDIT APPLICATION
ACCT #
CONTACT INFO/OWNERSHIP NAME
DL# SOCIAL SECURITY #
ADDRESS
CITY
STATE
ZIP
PHONE # REQUESTED $$$ AMOUNT
CURRENT EMPLOYER
GAS CARD REQUESTED
ADDRESS
YES
THE UNDERSIGNED IS_____/IS NOT______ A PRODUCER OF AG PRODUCTS (COMMOM STOCK REQUIRES APPLICANT TO BE A PRODUCER OF AG PRODUCTS)
BUSINESS FINANCE INFO BANK NAME
BRANCH
BANK ADDRESS
PHONE
FAX
TRADE/CREDIT REFERENCES (UTILITIY COMPANIES, CREDIT CARD REF, ANY PLACE YOU DO BUSINESS) COMPANY NAME
PHONE
FAX
ADDRESS
CITY,STATE,ZIP
CONTACT
COMPANY NAME
PHONE
ADDRESS
CITY,STATE,ZIP
CONTACT
FAX
UNDER THE PENALITES OF PERJURY, I CERTIFY THAT THE INFORMATION PROVIDED ON THIS FORM IS TRUE, CORRECT AND COMPLETE AND THAT WE ARE NOT SUBJECT TO BACKUP WITHHOLDING PURSUANT TO INTERNAL REVENUE CODE SECTION 3406(d). WE CERTIFY THAT ALL THE INFORMATION ON THIS FORM IS CORRECT. WE FULLY UNDERSTAND YOUR CREDIT TERMS AND AGREE TO THE PROPER PAYMENT IN CONSIDERATION OF EXTENDED CREDIT. BY SUBMITTING THIS APPLICATION YOU AUTHORIZE PRO AG MARKETING TO MAKE INQUIRIES INTO THE BANKING & TRADE REFERENCES YOU HAVE SUPPLIED.
AUTHORIZED SIGNATURE(OWNER, OFFICER, OR PRINCIPAL)
TITLE
DATE
NO
CHARGE ACCOUNT AGREEMENT THIS AGREEMENT, MADE AND ENTERED ON THE ABOVE STATED DATE BY THE SAID CREDIT PATRON AND THE COOPERATIVE ASSOCIATION (NAMED ABOVE), PURSUANT TO THE CONSUMER CREDIT PROTECTION ACT (FEDERAL TRUTH IN LENDING ACT (FEDERAL TRUTH IN LENDING ACT, PUBLIC LAW 90-321; 82 STAT. 146) AND THE KANSAS UNIFORM CONSUMER CREDIT CODE (K.S.A. 16(a) 1-101 et seq). THE COOPERATIVE ASSOCIATION AGREES, IF THIS AGREEMENT IS APPROVED BY THE ASSOCIATION, THAT IT SHALL ALLOW THE CREDIT PATRON TO PURCHASE GOOD AND SERVICES ON CREDIT AND THE CREDIT PATRON AGREES TO PAY FOR ANY GOODS AND SERVICES IN ACCORDANCE WITH THIS AGREEMENT. •
ALL PURCHASE(S) MADE ON CREDIT DURING THE MONTH THAT ARE REFLECTED ON THE PERIODIC BILLING STMT FOR SUCH MONTH ARE DUE AND PAYABLE BY THE 15TH OF THE MONTH FOLLOWING PURCHASE
•
IF ALL PURCHASES ARE PAID IN FULL BEFORE THE 15TH DAY OF THE MONTH FOLLOWING THE MONTH OF PURCHASE, THE ACCOUNT SHALL NOT BE SUBJECT TO FINANCE CHARGE
•
ANY BALANCE NOT PAID BEFORE THE 15TH DAY OF THE MONTH FOLLOWING THE MONTH OF PURCHASE, SHALL BE SUBJECT TO A FINANCE CHARGE OF 1.2% PER MONTH WHICH IS AN ANNUAL PERCENTAGE RATE OF 14.4%, SAID F/C TO APPLY TO THE UNPAID BALANCE ON THE ACCOUNT ON THE LAST DAY OF BILLING CYCLE CARRIED OVER FROM THE PRIOR MONTH, AND THE MINIMUM AMOUNT OF SUCH CHARGE SHALL BE $.50 PER MONTH
•
THE COOPERATIVE RESERVES THE RIGHT TO TERMINATE CREDIT SALES TO PATRON AT ANY TIME WITHOUT PRIOR NOTIFICATION, AND IN ADDITION THERETO, NO ADDITIONAL CREDIT PURCHASES WILL BE ALLOWED TO ANY ACCOUNT THAT IS OVER 30 DAYS PAST DUE.
•
THIS AGREEMENT MAY BE CHANGED BY THE COOPERATIVE ASSOCIATION TO INCREASE THE FINANCE CHARGE, CHANGE THE DUE DATE, CHANGE THE BILLING CYCLE, CHANGE THE METHOD OF CALCULATING THE FINANCE CHARGE OR CHANGE MATTERS OF SIMILAR NATURE WITHIN THE LIMITATIONS OF APPLICABLE LAW. NOTICE OF ANY SUCH CHANGE SHALL BE GIVEN TO THE PATRON 30 DAYS PRIOR TO THE EFFECTIVE DATE OF CHANGE.
•
ANY PURCHASE(S) MADE PURSUANT TO THIS AGREEMENT SHALL BE SECURED BY A SECURITY INTEREST AND LIEN IN ANY INVESTMENT THE PATRON MAY HAVE IN THE COOPERATIVE ASSOCIATION. INVESTMENT MEANS ANY CERTIFICATES OF INDEBTEDNESS, NOTE, STOCK, OR STOCK CREDIT, OR REVOLVING FUND CREDIT OR PATRONAGE LEDGER CREDIT. THE PATRON DOES NOT HAVE THE RIGHT TO DEMAND OFFSET OF SUCH INVESTMENT ON HIS/HER ACCOUNT. SUCH AN OFFSET MAY BE MADE ONLY AT THE DISCRETION OF THE BOARD OF DIRECTORS OF THIS ASSOCIATION.
•
CREDIT PATRON AGREES TO PAY THE REASONABLE COSTS OF COLLECTION INCLUDING, BUT NOT LIMITED TO, ATTORNEY AND COLLECTION AGENCY FEES(BUT NOT BOTH), AND THE COURT COSTS, BUT SUCH FEES MAY NOT EXCEED 15% OF THE UNPAID DEBT AFTER DEFAULT, IN ACCORDANCE WITH KSA 16a-2-507 OR AS HEREAFTER AMENDED.
•
UNTIL NOTIFIED IN WRITING TO THE CONTRARY BY THE PATRON, THE COOPERATIVE ASSOCIATION MAY ASSUME THAT THE PATRON'S SPOUSE, CHILDREN OVER THE AGE OF SIXTEEN YEARS, AND EMPLOYEES, IF ANY AUTHORIZED TO PURCHASE GOODS OR SERVICES AND CHARGE THEM TO THE PATRON'S ACCOUNT
PERSONAL GUARANTEE WE (OR I) , the undersigned do hereby jointly, severally and personally guarantee the above purchasers full performance of said purchase agreement and hereby agree to indemnify Pro-Ag Marketing against any and all damages, loss expense (including attorney's fees) and/or liability sustained by Pro-Ag Marketing of Kensington, KS , by reason of or related to, the above purchaser's failure to perform or to pay when due, charges incurred in accordance with the above agreement. Pro Ag Marketing of Kensington, KS may enforce this agreement against the undersigned or any of them, jointly or severally whether or not any action is ever taken by it against the above purchaser.
GUARANTOR'S SIGNATURE (OWNER, OFFICER OR PRINCIPAL LISTED ABOVE)
TITLE
DATE
NAME (SPOUSE)
TITLE
DATE
** THIS APPLICATION WILL NOT BE PROCESSED WITHOUT A GARANTOR'S SIGNATURE, SS#, DL# AND TITLE
OFFICE USE: APPROVED FOR CREDIT BY REFERENCE RESULTS
DATE:
