j5tractors.com

  Application for Credit
   
List tractor and/or equipment being considered   
Applicant's name (Last, First, Middle)   
SS#   
Date of Birth   
Have you ever used AAC before?   No
Current physical address of residence (no PO box)   
City   
State / Province   
Zip / Postal code   
County   
Home telephone number   
Work or cell telephone number   
Marital status   Married    Unmarried   Separated
Years at current address   
E-mail address   
Name of nearest relative not living with you 
Relationship 
City 
State / Province 
Telephone number 
Type of business  Individual
Equipment use  Farm
County and State/Province in which
 equipment will be kept 
Employer 
City, State/Province 
Years 
Annual gross income
Source of other income 
Frequency and amount 
Do you farm?  Part time
Number of acres owned 
Number of acres rented 
Have you had any unsatisfied judgments rendered against you in the past 7 years, had equipment repossessed in the past 7 years, or been declared bankrupt in the past 10 years?  No
 Yes
Submit this application IF
1) this equipment is for FARM or CONSUMER use, AND
2) this application amount PLUS all existing debt payable to Agricredit is LESS THAN $50,000

Applicant: (1) affirms that the information provided in this application, including the reverse side if completed, is true and correct and given for the purpose of obtaining credit; (2) understands that if credit is extended, Agricredit Acceptance LLC, it's agents, servicers, affiliates and assigns ("AAC Entities"), will rely on such information to secure the indebtedness; (3) authorizes references to provide all relevant information to the AAC Entities; (4) authorizes the AAC Entities to investigate and obtain reports concerning credit history; and (5) authorizes the AAC Entities to release to, and share and exchange with : (a) any other AAC Entities, (b) any manufacturer of any equipment covered by this application, and (c) any dealer who may sell or lease any of the equipment covered by this application or who may submit or originate this application, any information concerning Applicant or Applicant's credit experience with the AAC Entities and their decision whether or not to extend any credit. Applicant waives any right to confidentiality that may exist with respect to the release, exchange or sharing of such information. The AAC Entities are authorized to retain any information obtained as part of the application process whether or not the requested credit is granted.
J5 Tractors, Inc.
P.O. Box 470
202 Hwy 39 South
Normangee, Texas 77871
Tel: (800) 223-6354 / Tel: (936) 396-6354
Fax: (936) 396-5061 		By submitting this application, I/we certify that everything stated in this Application is true to the best of my/our knowledge and I/we agree with all the terms stated above.
Date