APPLICATION INSTRUCTIONS

Transcription

1 APPLICATION INSTRUCTIONS To complete the application, follow these steps: 1. Fill in all the blanks on the applications all fields are clickable. 2. Print and return completed application to any location within the Fishback Family of Banks. Do not completed applications as we cannot guarantee the privacy and security of your . DOWNTOWN 520 6th Street BROOKINGS Phone: BANK Fax: EAST BANK th Street Phone: BANK Fax: HYVEE nd Avenue South Phone: Fax: WALMART SUPERCENTER th Street Phone: Fax: VERMILLION 20 East Main Street Vermillion, SD Phone: Fax: GARRETSON 644 North Main Avenue Garretson, SD Phone: Fax: SIOU FALLS DOWNTOWN 110 North Minnesota Avenue Sioux Falls, SD Phone: Fax: TH & I West 57th Street Sioux Falls, SD Phone: Fax: East 5th Street Canton, SD CANTON Phone: Fax: MADISON 120 North Egan Avenue Madison, SD Phone: Fax: WATERTOWN th Avenue Southeast Watertown, SD Phone: Fax: PIPESTONE 101 Northwest 2nd Street Pipestone, MN Phone: Fax: MILBANK 215 West 4th Avenue Milbank, SD Phone: Fax: STOCKHOLM 102 South Main Street Stockholm, SD Phone: Fax: Main Avenue Toronto, SD TORONTO Phone: Fax: WHITE 301 West Main Street White, SD Phone: Fax: TOLL FREE: MEMBER FDIC

2 Agricultural Loan Application Date Bank Officer CIF (Primary) CIF (Joint) PRIMARY APPLICANT Applying as: Individual(s) Partnership Corporation Legal Name First Middle Initial Last Requested Amount / Purpose Physical Address Taxpayer ID # or Social Security # City / State / Zip Date of Birth Mailing Address Home Phone # ( ) City / State / Zip Cell # ( ) ID Type: Driver s Lic. Gov t ID Passport VISA Address Other ID # Where Issued Employer s Name Issue Date / / Exp. Date / / U.S. Citizen Resident Alien Non-Resident Alien Are you a co-maker, endorser or guarantor on any loan or account? Yes No Have you ever filed bankruptcy? Yes No Are there any judgments against you? Yes No Opening Method: In Person By Mail/Fax OFAC Authentication Cross Check (CBC) Non-Documentary Verification CIP Risk Rating: High Medium Low Additional Info JOINT APPLICANT Applying as: Individual(s) Partnership Corporation Legal Name First Middle Initial Last Requested Amount / Purpose Physical Address Taxpayer ID # or Social Security # City / State / Zip Date of Birth Mailing Address Home Phone # ( ) City / State / Zip Cell # ( ) ID Type: Driver s Lic. Gov t ID Passport VISA Address Other ID # Where Issued Employer s Name Issue Date / / Exp. Date / / U.S. Citizen Resident Alien Non-Resident Alien Are you a co-maker, endorser or guarantor on any loan or account? Yes No Have you ever filed bankruptcy? Yes No Are there any judgments against you? Yes No Opening Method: In Person By Mail/Fax OFAC Authentication Cross Check (CBC) Non-Documentary Verification CIP Risk Rating: High Medium Low Additional Info APPLICANT INTENT If you intend to apply for joint credit, initial here: ACKNOWLEDGMENT Applicant Joint Applicant Applicant Signature Date Joint Applicant Signature Date Page 1

3 NOTE: Please use additional pages, if needed, and include them when submitting the application. CURRENT ASSETS AMOUNT CURRENT LIABILITIES AMOUNT Cash Notes Payable (Due within 1 year) Checking Account(s) (Lender) Savings Account(s) CD(s) (Others) Notes & Accounts Receivable (Schedule F) Livestock Held for Sale # Head Type Weight Other Accounts Payable Grain & Feed on Hand (Schedule C) Sealed Grain (Schedule C) Cash Investment in Growing Crops (Schedule C) Prepaid Expenses Personal Assets Interest Due FBT Other Cash Rent Due Lease Payment Due Real Estate Taxes Payable Income Taxes Payable Medical Expenses Current Assets Current Liabilities INTERMEDIATE TERM ASSETS Titled Machinery & Equipment (Schedule H) Ex: FSA Rate Payment Due Date Balance Non-titled Machinery & Equipment (Schedule H) Cash Value Life Insurance (Schedule E) Bonds & Securities (Schedule D) Livestock Held for Breeding or Production (Schedule B) AMOUNT INTERMEDIATE TERM LIABILITIES Intermediate Assets Intermediate Liabilities LONG TERM OR FIED ASSETS AMOUNT LONG TERM LIABILITIES Farm Real Estate (Schedule A) Ex: FSA Payment Due Date Amount Other Real Estate (Schedule A) Pensions and/or Annuities (Vested Interest) Fixed Assets Assets Long Term Liabilities Liabilities Liabilities & Net Worth Farm Insurance $ Is any legal action pending against you? Yes No Crop Insurance $ Do you carry health, accident or hospital insurance? Yes No Do you have an estate plan? Yes No Page 2

4 SCHEDULE A REAL ESTATE (OWNED OR RENTED) Farm Real Estate - OWNED Acres Description & Location Owners Cost Value Liens Due Date Mortgage Holder Non-Farm Real Estate - OWNED Farm Real Estate - RENTED Acres From Whom Description & Location Terms SCHEDULE B LIVESTOCK & POULTRY Livestock & Poultry Held For Breeding or Production Purposes Number Description Weight Value/Unit Value SCHEDULE C CROPS OR FEED ON HAND OR GROWING Held for Breeding or Production Crop or Amount on Hand Sealed Market Cash Invested In Feed (Bushels or Tons) (Y/N) Value Growing Crops SCHEDULE D BONDS & SECURITIES Number of Shares or Par Value Bonds Description Market Value Page 3 Market Value

5 SCHEDULE E LIFE INSURANCE Insurance Company Beneficiary Face Value Cash Value SCHEDULE F NOTES & ACCOUNTS RECEIVABLE Due From Source Amount Payable SCHEDULE G LEASED MACHINERY & LIVESTOCK Description Leased From Terms of Lease SCHEDULE H MACHINERY & EQUIPMENT Machinery & Equipment - NON-TITLED Year Description % Ownership Cost Market Value NON-TITLED Machinery & Equipment Machinery & Equipment - TITLED Year Description % Ownership Cost Market Value TITLED Machinery & Equipment NON-TITLED Machinery & Equipment Machinery & Equipment Change in Net Worth Due to Change in Asset Valuations (Cost Market Value) APPLICANT INTENT If you intend to apply for joint credit, initial here: ACKNOWLEDGMENT Page 4 January 2012 Applicant Joint Applicant Applicant Signature Date Joint Applicant Signature Date