United Ag Credit Reference Authorization printable pdf download

United Ag Credit Reference Authorization

Credit Reference Authorization

To: __________________________________________________

Date: ___________________

Account Number: ________________________

I, __________________________________________ Hereby Authorize You to Furnish the

(Please print)

Following Information to United Agricultural Cooperative, Inc.

_________________________________________________________

(Signature)

Date Account Opened: _______________________________________________________________

Account Terms: ____________________________________________________________________

Recent High Balance: ________________________________________________________________

Current Balance: ____________________________________________________________________

Amount Past Due: ___________________________________________________________________

Times Over:

30 days ______________

60 days _____________ 90 days _____________

How would you rate this applicant’s payment history?

Excellent ____________

Fair _____________

Poor _____________

Comments: ________________________________________________________________________

__________________________________________________________________________________

___________________________________________

___________________________________

(Signature)

(Title)

Thank you for supplying the above information. We will keep this form in confidence.

United Ag Credit Reference Authorization