Agforce Customer Credit Application Company Information The undersigned company is applying for credit with and agrees to abide by the standard terms and conditions of as printed. Fields marked with a red "*" are required. Agforce Sales Person or Account Manager required Terry Ahern Mitchell Anderson Amanda Archer Jason Beinke Cody Botkin Davis Carpenter Ryan Chancey Brett Coberly Tony DePratt Joe Green Dan Green Jacob Hoselton Jacob Peterson Michael Preisinger Becka Watkins Cole Spencer Chris Stranckmeyer Jonny Wirtz Jeremy Brouhard Wayne Martin George Vial Jordan Benson Other Please select your sales or account person at Agforce. Full Company Name DBA (if different than Company Name) Primary Contact Person required Address required State Armed Forces America Armed Forces Armed Forces Pacific Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico New York Nevada North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Primary Phone Number required Fax Number (if applicable) Email Address required Federal Tax ID or Social Security Number required Date business established? required Sales Tax Exempt? required Yes No What type of company are you? required Please select one. Corporation Partnership Sole Proprietor Another type of company Amount of credit requested? required Invoicing/Accounting Contact Name required Invoicing/Accounting Contact Phone Number required Invoicing/Accounting Contact Email Address required Your Company Trade References Reference #1 Name required Address required State Armed Forces America Armed Forces Armed Forces Pacific Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico New York Nevada North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Phone Number required Fax Number Email Address Reference #2 Name Address State Armed Forces America Armed Forces Armed Forces Pacific Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico New York Nevada North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Phone Number Fax Number Email Address Reference #3 Name Address State Armed Forces America Armed Forces Armed Forces Pacific Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico New York Nevada North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Phone Number Fax Number Email Address Trade Reference Sheets Please attach any trade reference sheets or additional credit application information below. We accept PDF file types only. Please attach your trade reference sheet below Upload or drag files here. PDF type only Please attach any additional credit application information below Upload or drag files here. PDF type only Your Company's Banking References Bank Reference #1 Account Number Name of Bank Bank Phone Number Contact Person at Bank Bank Address State Armed Forces America Armed Forces Armed Forces Pacific Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico New York Nevada North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Bank Reference #2 Account Number Name of Bank Bank Phone Number Contact Person at Bank Bank Address State Armed Forces America Armed Forces Armed Forces Pacific Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Jersey New Mexico New York Nevada North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Credit Terms The customer understands that the terms of which Agforce grants credit are: Accounts are due and payable on the terms of net 30-day terms from date of invoice. Invoices for which payment not received in Agforce offices within payment terms are subject to service charge at 1.5% monthly, 18% annually. I/WE AGREE that a service charge of 18% per annum (1.5% per month) may be assessed on items outstanding beyond our terms of 30 days and will be added to my/our account, and will be payable immediately. Service charges unpaid shall form part of the account balance. Accounts not paid within terms will not be extended further credit until past due balances are paid in full. I/WE AGREE that the company shall have the right from time to time on at least 30 days’ notice in writing to me/us a the above address to make a change in the rate of the service charge on new purchases made by me/us after the date of expiration on the notice. THE FOREGOING is subject to my/our right to repay all or part of my/our total indebtedness at any time. The above information is provided for the purpose of extending credit to our company on terms of 30-days from date of invoice. To the best of our knowledge and belief, the information is accurate and may be relied upon in making a credit decision. We authorize our bank and suppliers to furnish you any information necessary to complete your evaluation of our credit history. GENERAL TERMS AND CONDITIONS Invoices are sent when service is performed. All invoices become payable-in-full 30 days from invoiced date. A service charge may be added to all outstanding amounts invoiced if not paid by end of the 30 days. No additional credit will be extended to past due accounts unless satisfactory arrangements are made with our credit department. I represent that the above information is true and is given to induce to extend credit to the applicant. My company and I authorize Agforce Logistics, LLC dba Agforce Transport Services to make such credit investigation as sees fit, including contacting the above trade and bank references and obtaining credit reports. My company and I authorize all trade references, banks, and credit reporting agencies to disclose to any and all information concerning the financial and credit history of my company and myself. I have read the terms and conditions stated below and agree to all of these terms and conditions. Authorized Signature required Title required Printed Name required Date Signed Submit Application