Dealer Equipment Finance Application

Applicant:
1

Name*

Best Ph # to Reach You*

Social Security #

Date of Birth*

Email*

Street Address*

City*

State/Zip*

County*

Years Farming*

Primary Ag Product*

Acres Owned*

Rented*

Financial:
2

Assets $*

Liabilities $*

Gross Farm Income $*

Business Responsible for the Debt If Financing Under a Business Name Business Name

Federal Tax ID#

Yrs in Business

Street Address

City

State/Zip

Business Type

State of Incorp.

Equipment:
3

Tot. Purch. Price* $

Year*

Manufacturer*

Model*

Trade In $ (if Apply)

Payoff $

Will this be used for custom work?* Y N

Signature/Title*

Date*

Dealer Name


By submitting this Application, the undersigned warrants that the applicant and each individual listed as a principal, partner, owner, guarantor or obligor consent, authorize and warrant as follows:(a) Ag Equipment Finance, LLC. and its agents (AEF) may obtain commercial and consumer credit reports, investigate references and statements, and make other credit inquiries about the applicant and all such individuals, and anybody contacted in connection therewith may release any credit and financial information; (b) AEF and its affiliates may share with one another financial, credit and other information about the applicant and such individuals and use shared information to market to the applicant and the individuals; (c) the information on or accompanying this Application is true and complete, and the undersigned will notify AEF of any material change in any information; (d) this Application is submitted in connection with financing solely for business and commercial purposes and NOT for personal, family or household purposes; (e) the applicant, if an individual, is a citizen or lawful permanent resident of the United States; and (f) this Application will apply to any future request for additional financing and all notices, disclosures, consents and warranties shall be deemed repeated for each future request, unless the applicant submits a new written application. AEF does not make offers or commitments to extend credit except in final signed documents and, in limited circumstances, in and pursuant to the terms and conditions of written commitment letters. Term sheets, proposal letters, approval letters and the like are not commitment letters. EQUAL CREDIT OPPORTUNITY ACT. If your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please contact Ag Equipment Finance at 218-304-1372 within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement. NOTICE:The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided 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 Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Office of the Comptroller of the Currency, Customer Assistance Group, 1301 McKinney Street, Suite 3450, Houston, Texas 77010-9050.