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Confidential Credit Application
Please complete the Credit Application carefully. Any application not filled out completely will not be considered. Typically, it may take four to six weeks for credit approval depending on the cooperation of your credit references.
Date
NAME AND ADDRESS INFORMATION
Legal Name of Business
BusinessName
Shipping Address
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Belarus
Belgium
Belize
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Cambodia
Cameroon
Canada
Caribbean
Chile
China
Colombia
Congo (DRC)
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Czechia
Denmark
Djibouti
Dominican Republic
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Greenland
Guatemala
Haiti
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kuwait
Kyrgyzstan
Laos
Latin America
Latvia
Lebanon
Libya
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, FYRO
Malaysia
Maldives
Mali
Malta
Mexico
Moldova
Monaco
Mongolia
Montenegro
Morocco
Myanmar
Nepal
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Singapore
Slovakia
Slovenia
Somalia
South Africa
Spain
Sri Lanka
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Venezuela
Vietnam
World
Yemen
Zimbabwe
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Billing Address
Same As Shipping
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Belarus
Belgium
Belize
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Cambodia
Cameroon
Canada
Caribbean
Chile
China
Colombia
Congo (DRC)
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Czechia
Denmark
Djibouti
Dominican Republic
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Greenland
Guatemala
Haiti
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kuwait
Kyrgyzstan
Laos
Latin America
Latvia
Lebanon
Libya
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia, FYRO
Malaysia
Maldives
Mali
Malta
Mexico
Moldova
Monaco
Mongolia
Montenegro
Morocco
Myanmar
Nepal
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Singapore
Slovakia
Slovenia
Somalia
South Africa
Spain
Sri Lanka
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Venezuela
Vietnam
World
Yemen
Zimbabwe
Address1
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
PostalCode
PhoneNumber
FaxNumber
First Name
UserFirstName
Last Name
UserLastName
E-mail Address
BusinessEmail
ORGANIZATION INFORMATION
Organization Type
OrganizationType
Corporation
Limited Liability Company
General Partnership
Limited Partnership
Sole Proprietorship
Annual Sales Volume
$
AnnualSalesVolume
Number of acres in production
NumberOfAcresInProduction
Have you ever declared bankruptcy?
Yes
No
Have you ever done business under another name?
Yes
No
Have you ever had credit with us or purchased from us before?
Yes
No
OWNERS, PARTNERS, OFFICERS AND/OR STOCKHOLDERS INFORMATION
Please enter a minimum of one (maximum of two)
Name
Contact Address
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Phone Number
E-mail
Position
Add Contact
ACCOUNT INFORMATION
Amount of Credit Desired
$
AmountOfCredit
Account's Payable Contact
Account's Payable Phone Number
Account's Payable Email
TERMS AND CONDITIONS
For questions about terms and conditions please e-mail
creditapplication@expressseed.com
The information given here will be relied upon as correct and will be kept in strict confidence by our Credit Department. I (we) authorize you to obtain information from the references listed in this credit application.
CORPORATE GUARANTEE
Please complete and sign the Corporate Guarantee and Individual and Partnership Guarantee below. If you are not a corporation you may skip this section.
I,
, certify that I am the
Title
of
CompanyName
, organized under the laws of the state of
State
. Application is hereby made for an Account with Express Seed Company, I accept the terms and Conditions above. In consideration of the extension of credit granted by Express Seed Company, the corporation guarantees payment of whatever amount shall at any time be owing to Express Seed Company on account of goods hereafter delivered, whether said indebtedness be in the form of notes, bills, or open account. The corporation guarantees payment of all interest and service charges due and all cost collection, including but not limited to, court costs and reasonable attorney fees.
INDIVIDUAL OR PARTNERSHIP GUARANTEE
Signature of Authorized Party is required to process application.
Application is hereby made for an Account with Express Seed Company, I (we) accept the terms and Conditions above. In consideration of the extension of credit granted by Express Seed Company to
. I (we) hereby jointly and severally unconditionally guarantee payment of whatever amount shall at any time be owing to Express Seed Company on account of goods hereafter delivered , whether said indebtedness be in the form of notes, bills or open account. The undersigned additionally jointly and severally unconditionally guarantees payment of any interest and service charges due on all cost of collection, including but not limited to, court costs and reasonable attorney fees.
PrintedName
DateSigned
Relationship
EXPRESS SEED COMPANY CREDIT DEPARTMENT
New customers may skip this section
Customer Number
Sales Person
April Evers
Anik Graves
Ann Yonkof
Brett Alldredge
Ben Baum
Brian Peruski
Broker - Ball
Broker - Eason
Broker - Germania
Broker - Griffin
Broker - Messick
Broker - Michells
Broker - Vandenberg
Chris Capps
Chris MacLaggan
Christopher A. Neumann
Duane Brodbeck
David Keeler
Dick Shreve
Daniel Webber
Earl Waddell
Express Seed
Greg Woodward
Heather Lilja
Heather VonAllmen
Inactive
Isaac Stern
Jacki Armstrong
Joe Bergen
Joel Kempfer
Jonathan Russell
Joey Wiseman
Kyle Brupbacher
Express Seed - Key Accounts
Kimberly Porter
Lovette Johns
Linda Lonigro
Lyndsey Rico
Megan Creighton
MaryJane Schermer
Phil Brennessel
Pierre Charbonneau
Raquel Feigenbutz
Rick Grossman
Rachel Kaufman
Ryan ONeil
Rob VanStaalduinen
Steve Bible
Sarah Gibbs
Scott Krohn
Sabrina Vanderwal
Tim Quirk
Zoltan Kovacs
I dont have/know my sales representative
REQUEST FOR CREDIT INFORMATION
I,
, certify that I am the
of
. I hereby authorize the release of certain credit information requested in writing as listed below to Express Seed Company.
TRADE REFERENCES
Please enter a minumum of three (maximum of four)
Name
Contact Address
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Phone Number
E-mail
Fax Number
Add Reference
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