Farm Credit Express Credit Application

Name*
Address Line 1*
Street Address
Address Line 2
Address Line 2
City*
City
State*
State / Province / Region
Zipcode*
ZIP / Postal Code
Home Phone Number
Cell Phone Number*
Date of Birth*
MM slash DD slash YYYY
Gross Farm Income*
Annual Salary*
Primary Farm Product*
Secondary Farm Product*
Year Began Farming*
Product Name to Purchase*
Price*
Terms*
Payment Terms*
A Social Security Number is necessary to complete the application. May we call you to obtain that number?*
- Yes
- No
Are you an American citizen?*
- Yes
- No
Do we have permission to run a credit check?*
- Yes
- No

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