Dave's Tractor, Inc Credit Application - Agricredit Acceptance LLC

All fields of information requested below require a response.  If you do not have a response please enter "no response" or "n/a" (for not applicable).

List tractor and/or equipment being considered: 
Applicant's name (Last, First, Middle): 
U.S. Citizen?


Social Security Number: 
Have you ever used AgriCredit before?


Date of Birth: 
Mailing Address:
City: 
State / Province: 
Zip / Postal Code: 
Physical Address of Residence:
County:
Years at current address:
Marital Status:


Home telephone number: 
Work or cell telephone number: 
E-mail address: 
Employer (Name and Address):
Years at Current Job:
Annual Gross Income:
Type of business:  Individual Corporation  Sole-Proprietorship  Partnership
Have you had any unsatisfied judgments rendered against you in the past 7 years, had equipment repossessed in the past 7 years, or been declared bankrupt in the past 10 years?  Yes No
Submit this application IF

1) this equipment is for FARM or CONSUMER use, AND
2) this application amount PLUS all existing debt payable to Agricredit is LESS THAN $50,000

Applicant ...
  1. affirms that the information provided in this application is true and correct and given for the purpose of obtaining credit;
  2. understands that if credit is extended, Agricredit Acceptance LLC, it's agents, servicers, affiliates and assigns ("AAC Entities"), will rely on such information to secure the indebtedness;
  3. authorizes references to provide all relevant information to the AAC Entities;
  4. authorizes the AAC Entities to investigate and obtain reports concerning credit history; and authorizes the AAC Entities to release to, and share and exchange with :
    1. any other AAC entities,
    2. any manufacturer of any equipment covered by this application, and,
    3. any dealer who may sell or lease any of the equipment covered by this application or who may submit or originate this application, any information concerning Applicant or Applicant's credit experience with the AAC Entities and their decision whether or not to extend any credit. Applicant waives any right to confidentiality that may exist with respect to the release, exchange or sharing of such information. The AAC Entities are authorized to retain any information obtained as part of the application process whether or not the requested credit is granted.
By submitting this application, I/we certify that everything stated in this Application is true to the best of my/our knowledge and I/we agree with all the terms stated above. My initials in the appropriate following box serve as my digital signature and authorization for this application. 

Approval Initials:     Date:

If you would like to print a copy of your application
before submitting it, click here.