Agriculture Loan

Loan Information

• Application Type *
  Individual Joint
• Amount Requested *
• Loan Type *
  Individual Unsecured Initial Request Additional Advance
• Loan Purpose *
• Applicant Name *
• Co-Applicant Name *
• Applicant's Address *
• Email *
• Phone *
• Cell Phone *
• Applicant Taxpayer ID *
• Applicant Date of Birth *
• Co-Applicant Taxpayer ID *
• Co-Applicant Date of Birth *
• Business Year End Date

General Information

• Legal Relationship *

  Corporate Partnership Sole Proprietor Other
• Years in this Business
• Year Business Established
• Formation Date
• Principal Banking Relationship with
• County of Residence
• Other Employment
• Phone Number *
• Annual Salary
• Position

Insurance Information

• Farm Property Insurance Agency
• Agency Address
• Agent's Name
• Phone

Credit References

• Primary Lender

  Name
• Address
• Phone
• Contact Person

• Fertilizer Dealer

  Name
• Address
• Phone
• Contact Person

• Primary Seed Dealer

  Name
• Address
• Phone
• Contact Person

Capital Payment Information

• Equipment Payments

  Lender/Type
• Current Balance
• Annual Payment
• Lender/Type
• Current Balance
• Annual Payment
• Lender/Type
• Current Balance
• Annual Payment
• Lender/Type
• Current Balance
• Annual Payment

• Land Payments

  Lender/Lessor
• Current Balance
• Annual Payment
• Lender/Lessor
• Current Balance
• Annual Payment
• Lender/Lessor
• Current Balance
• Annual Payment
• Lender/Lessor
• Current Balance
• Annual Payment
• Total Acres Owned
• Total Acres Rented

• Are you a comaker, cosigner or guarantor on any loans? *

  Applicant *

  Yes No
  Co-Applicant *

  Yes No

• Are there any unsatisified judgments against you? *

  Applicant *

  Yes No
  Co-Applicant *

  Yes No

• Have you declared bankruptcy in the last ten years? *

  Applicant *

  Yes No
  Co-Applicant *

  Yes No

• Are you a defendant in any pending lawsuit(s)? *

  Applicant *

  Yes No
  Co-Applicant *

  Yes No

• Does anyone else own an interest in the property listed? *

  Applicant *

  Yes No
  Co-Applicant *

  Yes No

• Are any of your assets held in trust? *

  Applicant *

  Yes No
  Co-Applicant *

  Yes No

• Have you ever applied for a loan or a lease with FSB? *

  Applicant *

  Yes No
  Co-Applicant *

  Yes No

• Are any of your business or personal accounts past due? *

  Applicant *

  Yes No
  Co-Applicant *

  Yes No
• Other Comments or Information

Signatures: I certify that everything I have stated in this application and on any attachments is correct. Lender may keep this application whether or not it is approved. By typing my name below and submitting the form, I authorize Lender to check my personal and business credit and employment history and to answer any questions others may ask Lender about my credit record with Lender. I understand that I must update credit information, at Lender's request if my financial condition changes.

• Applicant Signature *
• Co-Applicant Signature *
• Bank Representative