Name:

Address: (line 1)

Address: (line 2)

City:

State:

Zip Code:

Phone:

Email Address:


Occupation

Full-Time FarmerPart-Time FarmerOther

Year Began Farming:


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Where is your operation located?

Incorporated / Operated State:

County:

Acres Operated:


Company Type:

Individual/Sole PartnershipTrustPartnership GeneralPartnership LimitedLimited Liability CompanyCorporationOther

Loan Type:

OperatingIntermediate TermMortgageLease for equipmentLeasehold development

Collateral Type:

Real EstatePersonal PropertyUnsecured

Payment Frequency:

MonthlyQuarterlySemi-AnnualAnnual

Are you interested in purchasing life insurance to cover your loan balance?

YesNo


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Special packages are offered to qualifying young, beginning, small and emerging market producres.

Please identify your status below and an appropriate loan officer will contact you.

?

Emerging Market Producer definition

A small to medium local food producer or aggregator (Farm-related service) selling products via a shortened supply chain with value added merchandising products to targeted buyers.

Are you under 35 years of age?

YesNo

Have you been farming for less than 10 years?

YesNo

Does your business have gross revenue of less than $250K annually?

YesNo

Are you an emerging market/niche business producer or aggregator?

YesNo

Authorization and Release of Information


I declare that I am over 18 years of age and legally authorized to submit and receive all related information.

Human Check:

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