Items in RED are REQUIRED. Items in BLACK are OPTIONAL
Applicant Name:
Type of Applicant: Individual(s) Corporation Partnership Trust
Other
Contact Name:
Spouses Name:
Address:
City: State: AL AK AS AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:
Daytime Phone #: (123)456-7890
Evening Phone #:
Mobile Phone #: Fax #:
Best time of day to contact:
E-mail:
Amount of Loan Request: example: 500,000
Describe general purpose (use of funds) for loan request (refinance other debt, purchase land, cash out, etc):
Describe agriculture property offered as collateral for requested loan:
Number of Acres: Estimated Value:
Location of collateral property, County and State:
Indicate the primary agricultural commodities produced on the land offered as security:
Please Indicate which of the following best describes your credit history (do NOT order a credit report on yourself):
Excellent history, no derogatory, very limited delinquency, high score Good history, no derogatory, minor delinquency, good score Some adverse history or minor derogatory(s), few delinquencies, reasonable score Poor history, multiple derogatory(s), and/or multiple repeating delinquencies
