Social Security Number ____-___-______
Taxpayer Number ___-____________

Name ________________________________ Co-Applicant_________________________
Address___________________________City_________________State_____Zip_______

Township_____________________County__________________Phone_______________

Store Location:
Erie______ Union City_________ Saegertown

This application is for:
Open Account_________ Deferred $___________Account to Note_________

To be re-paid as follows:_____________________________________________________

What person(s) are authorized to use this account:
_________________________________________________________________________

Acres_________ Tillable Acres__________ Present Value___________

Other Real Estate ____________________ Present Value___________

Cows _______Yearly Production ________ Present Value___________
Heifers & Calves__________ ___________ Present Value___________

Layers ____________Age________
Pullets ____________Age_________

Other Livestock______________________ Present Value___________

Machinery and Equipment____________________________________

Present Value_______________________

Cars and Trucks ___________________________________________

Present Value_______________________

Farm produce on hand to be sold (describe) ______________________________________
_________________________________________________________________________

Present Value_______________________

Notes and accounts due me (describe)__________________________________________

_________________________________________________________________________

Loan or cash value in life insurance_____________________________________________
_________________________________________________________________________

Stocks and Bonds__________________________________________________________

Cash on Hand_________________________

Farm products to be fed or used on the farm ______________________________________
__________________________________________________________________________

Other Assets (describe) ______________________________________________________
Total Assets $ ______________________

Cash Grown Crops:
Crop_____________________ Acres_________________
Crop_____________________ Acres_________________

Financial Institution:
Name_______________________
Address_____________________

____________________________

Farm Deed and other Real Estate in the name of:
___________________________________________________________________________

Pledged future farm income to:
___________________________________________________________________________

Guaranteed notes for other totaling: $________________________

Major source of income: __________________________________

Check in name of: _______________________________________

See accompany statement(s) for important, the terms of said statement(s) are incorporated by reference herein and made a part hereof.

The undersigned has delivered this financial statement to Erie-Crawford Cooperative to induce Erie-Crawford Cooperative to extend credit to the undersigned. The undersigned that Erie-Crawford Cooperative will rely on the truth, accuracy, and completeness of this financial statement. The undersigned certifies that the information inserted herein has been carefully read and is true, correct and complete.

Signed this __________________day of ______________20___

Name:
__________________________________

__________________________________
Signature of Co-Applicant

In CONSIDERATION for the sale of goods and services by Erie-Crawford Cooperative, 7733 Rt. 97, PO Box 312, Union City, PA 16438 (the "Cooperative") to the Undersigned on OPEN ACCOUNT credit for commercial farm production and agricultural business purposes, Undersigned agree(s) to pay the Cooperative all amounts due to the Cooperative for goods and services purchased according to the following terms and conditions:

1. Undersigned agree(s) to pay the cash price of goods and services purchased on OPEN ACCOUNT credit within thirty (30) days of the date of the invoice on which the goods and services purchased are first billed.
   
2. Undersigned agree(s) that is the total amount of an invoice is not paid within thirty (30) days, a FINANCE CHARGE shall be added to the unpaid balance. The unpaid balance will include any amounts remaining unpaid from the previous statement (the "Previous Balance") less payments and/or credits received by the Cooperative prior to the current billing date.
   
3. Undersigned agree(s) that the amount of the FINANCE CHARGE shall be computed on the balance due on each invoice at a periodic rate of 1.5% per month, which equals an ANNUAL PERCENTAGE RATE of 18%, with a minimum monthly FINANCE CHARGE on overdue invoices of .75 cents.
   
4. Undersigned agree(s) that the Cooperative will send to Undersigned a statement each month which will show a Previous Balance, purchases, payments, and other applicable charges, including FINANCE CHARGES, and credits, if any, which have been applied to the account since the previous statement, and a New Balance.
   
5. Undersigned hereby authorize(s) the Cooperative to investigate my/our credit record and report to credit reporting bureaus and organizations and any other creditors my/our performance under this agreement.
   
6. Undersigned agree(s) that a discount of %2 of the cash price for goods and services purchased will be applied if payment is made in full at the time of purchase. The 2% discount will not be given if, at the time of purchase, the Undersigned owes any unpaid balance or FINANCE CHARGES to the Cooperative.
   
7. Upon default in the payment of any sum when and as due hereunder, the undersigned hereby authorize(s) and empower(s) the prothonotary or any attorney of any court of record within the Commonwealth of Pennsylvania to appear for undersigned and, with or without one or more complaints filed, confess or enter judgment or a series of judgments against the undersigned in any court of record within the Commonwealth of Pennsylvania in favor of the Cooperative, its successors and assigns, for the unpaid principal balance and all interest accrued and then due, plus the costs of suit and an attorney’s commission of ten (10%) percent of the amount due, but in no event less than $500.00, for the collection of such sums, and undersigned hereby forever waivers and releases any and all errors in said proceedings and waives stay of execution and stay, continuance or adjournment of sale on execution. The authority and power to appear for and enter judgment against undersigned shall not be exhausted by one or more exercises thereof and may be exercised from time to time and as often as the Cooperative or its successors and assigns shall deem necessary or desirable.
   
8. Undersigned agree(s) to waive any and all set-offs, (including but not limited to equity in capital stock preferred stock, revolving-fund and/or dividend certificates), counterclaims, and/or defenses Undersigned has or may have in the future against the Cooperative relating to the extension of credit to the Undersigned by Cooperative or any other business transactions Undersigned may have with the Cooperative.
   
9. Undersigned acknowledge(s) and represents(s) that all goods and services purchased from the Cooperative are intended for and shall be used solely for business and/or commercial purpose.
   
10. Undersigned agree(s) that this Agreement shall be binding upon the Undersigned and his/her/their respective heirs, legal representatives, successors and assigns.
    
11. Undersigned acknowledge(s) having read and received a complete and executed copy of this Agreement and that there are no blanks contained herein.
    
    
    

If the Real Estate upon which Undersigned conducts farming operations is owned by more than one person or business entity, all record owners must sign this agreement.

If Undersigned does not own Real Estate, Please place an "X" Here _________

In Witness Whereof, the parties have placed their hands and seals this ______day of
_____________, 20___.

 

Buyers Signature:_________________________________________________(seal)

Address:_____________________________________________________________

Co-Buyers Signature:_______________________________________________(seal)

Address:______________________________________________________________

ERIE CRAWFORD COOPERATIVE

By:_________________________________

Title:________________________________