Information will be kept strictly confidential.             *=Mandatory Fields

 

Application for  Loan  Lease     Today's Date:*   (MM/DD/YYY)

  Dealership/Store Name* Store Location* Salesperson*
   

 

Applicant is:   

Proprietorship     Corporation     LLC     Partnership     Limited Partnership

Applying for:   

Individual credit, in my own name, relying on my own income and assets

Individual credit, relying on my income or assets, as well as income and assets from other sources

Joint Credit    

Primary Farm Product Produced*

Secondary Income Source

Business Name                      

Tax ID Number

Years in Business

Business Phone     

Business Fax

Business Address

City

State

County

Zip

APPLICANT INFORMATION CO-APPLICANT INFORMATION

Applicant Name*

 

Co-Applicant Name

Applicant Social Security No.* (Taxpayer ID)

 

Co-Applicant Social Security No. (Taxpayer ID)

Applicant Date of Birth*

 Applicant Email Address

 

Co-Applicant Date of Birth

 CoApplicant Email Address

Address* 

 

Address

City*

State*

County*

    Zip*

 

 

City

State

County

 Zip

Home Phone*

Work

Cell

 

Home Phone

Work

Cell

Yr Began Farming*

 U.S. Citizen*

 

Yes  No

Yr Began Farming

 U.S. Citizen*

Yes  No

Employer’s Name

Employer’s Name

Employer’s Address 

Employer’s Address 

City

State

Zip

City

State

Zip

Annual Salary*

Other Income*

 

 

Annual Salary

Other Income*

Income (most recent full year)

 *Income derived from alimony, child support or separate maintenance payments need not be revealed unless the applicant wishes to have it considered as a basis for repaying the credit extension requested.

Gross Farm Income (annual)* 

$

Operating expense/Cost of goods sold (not incl. Depreciation and Interest)

$
APPLICANT ASSETS AND DEBTS CO-APPLICANT ASSETS AND DEBTS
   

Cash or Equivalent*  (Checking/Savings Balance)

Current Debts (due within 12mnths)

$

$

Cash or Equivalent (Checking/Savings Balance)

Current Debts (due within 12 mnths)

$

$

Other Current Assets

All Other Debt

$

$

Other Current Assets

All Other Debt

$

$

All Other Assets

Total Debts

$

$

All Other Assets

Total Debts

$

$

Total Assets

Total Annual Debt Payments (P&I)

$

$

Total Assets

Total Annual Debt Payments (P&I)

$

$

LOAN/LEASE INFORMATION

Amount Requested*

$

Purpose of Loan/Lease* (Equip description/make/model/yr)

 

Term Requested* (yrs)

Loan Rate Quoted

Lease Factor Quoted

 

%

Special Program Applies?: Yes No
If yes, what program?:

Payments

 Beginning:

Monthly             Quarterly

 

Semi-Annual     Annual

AutoDraft Requested:

Yes No

Requested Contract Date:  

Transaction Detail: (sale price, down payment, trade-in allowance, dealer cost)

Insurance Agent Name

Agent Phone Number

Additional Comments:

Credit Life Insurance

The purchase of Credit Life Insurance from the ACA is optional on loans.  Borrowers will not be discriminated against for refusing ACA Credit Life Insurance or for obtaining insurance elsewhere.

I (We) Request Credit Life Insurance or

I (We) Decline Credit Life Insurance

By signature hereto, the undersigned:  certifies the information is true and correct, authorizes MidAtlantic Farm Credit, ACA (Lender), from time to time, to make such inquiries and gather such information as the Lender deems necessary and reasonable concerning any information provided to the Lender.  Authorizes the Lender to make credit inquiries, verify credit, verify employment, and obtain credit agency reports regarding me/us (including spouses) and to provide credit information and its credit experience with me/us to other creditors.  The undersigned further understands and acknowledges that the ACA and vendor may use electronic means to transmit this and any other related document. If approved, I/We authorize funds from this loan/lease to be disbursed directly to the dealer.

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract); because all or part of the applicant's income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Protection Act. The Federal Agency that administers compliance with the laws concerning this creditor is the Farm Credit Administration, 1501 Farm Credit Drive, McLean, Virginia, 22102.

As part of assembling the loan application, the Lender will request a consumer credit report which will disclose information concerning your credit standing, creditworthiness and credit capacity.  This notice is given pursuant to the Fair Credit Reporting Act of 1970, Section 601 to 602, inclusive. If your loan is rejected because of derogatory information, this information will be disclosed to you upon receipt of a written demand therefore made to the Credit Reporting Agency from whom the credit report was received. (personal, family or household purposes)


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