Credit Application Form

Please fill out the form below or click here to download, complete, sign and return the form to B-W Feed & Seed Ltd.

Company Information

Legal Farm Name

Farm Address

Contact Person(s)

Billing Address

Phone Number

Cell Number

Fax Number

Email Address (if you do not have an email address, please click here to download form and submit to B-W Feed & Seed Ltd.)


Would you like to receive your invoices electronically by email?
YesNo


Name of salesperson who has been helping you


What type of farming do you do?


Bank Reference

Bank Name

Bank Address

Bank Phone Number


Credit References 1

Name of Company

Address

Contact Person

Phone Number

Email Address


Credit References 2

Name of Company

Address

Contact Person

Phone Number

Email Address


Credit References 3

Name of Company

Address

Contact Person

Phone Number

Email Address


Terms and Conditions

By checking the box below certifies the above information to be true and affirms that any credit given to be extended upon the basis of such information. It is the sole responsibility of the applicant to advise us of any changes to the information provided throughout the ongoing course of our relationship.

I/We agree that all purchases will be paid according to the stated terms on the invoice, and further agree to pay a service charge of 1.25% per month (15% per annum) on all past due amounts. Returned cheques will be subject to a $25 service charge.

I/We give consent to B-W Feed & Seed Ltd. to obtain any reports containing credit or personal information that is required in obtaining credit from B-W Feed & Seed Ltd. I/We declare that the information given on the application is true and accurate in every aspect. This declaration is made for the purpose of obtaining credit from B-W Feed & Seed Ltd. and will remain confidential.

Check the box below if you agree to the Terms and Conditions above. (Please note: you will not be able to submit the form without agreeing to the Terms and Conditions)