Farmer-Boy-catalog - Catalog - Page 353
Your Source for Genuine Name Brand Parts
Credit Application
Phone: (800) 845-3374
Phone: (717) 866-7565
Fax: (717) 866-9072
Email: info@farmerboyag.com
FARMER BOY AG, INC
50 West Stoever Avenue
Myerstown, PA 17067
CONFIDENTIAL APPLICATION FOR CREDIT
Individual/Company Name
FBA Account #
Current Mailing Address
Date
Telephone No.
Address(es) for Past 5 Years (if different from current)
PLEASE CHECK ONE:
Individual
Birth Year
Proprietorship
Partnership
Corporation
LLC
NAME OF OWNERS: Sole Proprietor, Partners, Officers or Principal Stockholders
Title
Name
Home Address
Home Phone
Title
Name
Home Address
Home Phone
Title
Name
Home Address
Home Phone
Type of Business
Number of Years in Business
Approximate Credit Requirements
$
TRADE REFERENCES OF 3 LARGEST SUPPLIERS/WHOLESALERS (PLEASE FILL OUT ALL COLUMNS)
Company Name
Phone
Fax/Email:
1.
2.
3.
*Please do not give banks, credit cards, or utilities as trades. Please provide fax # of trades to expedite your application.
Do you have any PAST DUE accounts payable, taxes, loan payments, or bankruptcy?
Have you been our credit customer before?
If so, when?
Under what name did you buy?
It is understood and agreed upon that Farmer Boy Ag, Inc. will obtain credit/trade references on the above individual, sole proprietorship, partnership, corporation or
company and any guarantors. It is understood and agreed that all amounts unpaid after thirty (30) days will be subject to a 1 ½% service charge per month (with a $5.00
minimum charge) which amounts to an annual rate of 18%, plus all reasonable collection fees, attorney’s fees and expenses. In consideration of the extension of credit
to the above named individual, sole proprietorship, partnership, corporation or company, I/we personally guarantee payment of all purchases made on behalf of the
above named individual, sole proprietorship, partnership, corporation or company.
Signature: _______________________________
Date: ___________________
Guarantor
Signature: _______________________________
Date: ___________________
Guarantor
FORM MUST BE FILLED OUT COMPLETELY TO BE PROCESSED
Order Online: www.FarmerBoyAg.com
REV. 12/27/23
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