Mail: John Deere Financial
P.O. Box 5328
Madison, WI 53791-9605
Fax:
1-800-732-0251
MULTI-USE ACCOUNT FAX COVER SHEET
Use this cover sheet when you are requesting an increase to a Special Terms credit limit.
Please use this cover sheet to shorten the decision time and assist us in getting the proper
credit for your customers.
Merchant Name: ___________________________________________________________
Merchant Number: ____________________Merchant Contact: _______________________
Merchant Phone Number: ______________ Merchant Fax Number: ___________________
EXISTING multi-use account customer
Account Number: _______________________________________________________
Customer Name: _______________________________________________________
Pending Manufacturer purchase?
Identify the manufacturer:
BASF Bayer Monsanto Syngenta Other: ___________________________
Please indicate the credit needs of the customer:
Total credit limit request $__________________________________________
(Regular credit limit + Special Terms credit limit)
Regular limit request $____________
Special Terms limit Request $________________
Multi-use accounts are a service of John Deere Financial, f.s.b.
FINANCIAL INFORMATION UPDATE FORM
For existing Preferred multi-use account customers only.
Check the one that applies:
Increase my Regular credit limit
Establish/Increase my Special Terms credit limit
Required General Information (Please print)
Account Name:
Address:
City:
Account #:
State:
Social Security #:
-
Email Address:
Merchant Name:
Business Structure:
$50,001 to $120,000*
$120,001 to $300,000*
Over $300,000*
Date:
Phone:
D.O.B:
Tax ID #:
County:
Zip:
Merchant Number:
Sole Proprietor
Limited Partnership
Corporation
Non-Profit
/
/
Phone:
General Partnership
Government
Limited Liability Company
Other
Complete, sign and submit this form.
Complete, sign and submit this form along with your two most recent years of lender-prepared (or equivalent)
balance sheets and supporting schedules. If a Partnership, Corporation or LLC, include most recent two years’
personal balance sheets with supporting schedules of the general partner, president, owner or managing member.
Complete, sign and submit this form along with two years lender prepared balance sheets and with the most recent
two years’ tax returns. If a Partnership, Corporation or LLC, include most recent two years’ personal tax returns
of the general partners, president, owner or managing member.
Balance Sheet Date
Cash, Checking, Savings
Securities
Accounts Receivable
Investment in Growing Crop
Feed & Grain Inventory
Market Livestock
Government Payments Receivable
Other Current Assets
Specify
Total Current Assets
ASSETS
CCC Loans
Operating Principal
Accounts Payable
Current Intermediate Debt
Current Long-Term Debt
Leases
Misc. Current Liabilities
Specify
$
$
$
$
$
$
$
$
$
Breeding Livestock
Machinery & Equipment
Vehicles
Other Intermediate Assets
Specify
Total Intermediate Assets
$
$
$
$
Real Estate Value
Buildings
Other Long-Term Assets
Specify
Total Long-Term Assets
$
$
$
$
LIABILITIES
$
$
$
$
$
$
$
Total Current Liabilities $
0.00
0.00
Notes Payable—Specify
Machinery & Equipment Loans
Vehicle Loans
Other Intermediate Debt
Specify
Total Intermediate Liabilities
$
$
$
$
Mortgage Loans
Other Long-Term Debt
Specify
$
$
$
0.00
0.00
$
0.00
Total Long-Term Liabilities $ 0.00
TOTAL ASSETS $
0.00
TOTAL LIABILITIES $ 0.00
*John Deere Financial reserves the right to request additional information if needed.
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Crop Production Information
1. Owned Acres: _____________________________ 2. Owned Tillable Acres: _____________________________
3. Total Share Rent Acres: ______________________ 4. Your Share Rent Acres:
+ ___________
5. Total Cash Rent Dollars Paid Per Year: $ _________
+ ___________
6. Total Cash Rent Tillable Acres:
Your Share of Total Crop Production (2+4+6): = ____________
_0
First Crop
Acres
Corn
Soybeans
Wheat
Cotton
Peanuts
___________
___________
_________
_________
_________
_________
_________
_________
_________
%
Irrigated
Avg
Yield
Double Second
Crop
Crop
_________% _________Y Y/ N/ N
_________% _________Y Y/ N/ N
_________% _________Y Y/ N/ N
_________% _________Y Y/ N/ N
_________% _________Y Y/ N/ N
_________% _________Y /YN/ N
_________% _________Y /YN/ N
_________
_________
_________
_________
_________
_________
_________
Crop Insurance Coverage
Contracted Crops
Price
%
Type & %
CAT/YP/RP/RPE/GRIP/GRP
CAT/YP/RP/RPE/GRIP/GRP
_________% $_________ _________%
CAT/YP/RP/RPE/GRIP/GRP
CAT/YP/RP/RPE/GRIP/GRP
_________% $_________ _________%
CAT/YP/RP/RPE/GRIP/GRP
CAT/YP/RP/RPE/GRIP/GRP
_________% $_________ _________%
CAT/YP/RP/RPE/GRIP/GRP
CAT/YP/RP/RPE/GRIP/GRP _________% $_________ _________%
CAT/YP/RP/RPE/GRIP/GRP
CAT/YP/RP/RPE/GRIP/GRP
_________% $_________ _________%
CAT/YP/RP/RPE/GRIP/GRP
CAT/YP/RP/RPE/GRIP/GRP
_________% $_________ _________%
CAT/YP/RP/RPE/GRIP/GRP
CAT/YP/RP/RPE/GRIP/GRP _________% $_________ _________%
If necessary to fulfill loan request, is a security position available on growing crops? Y/N
Crop Insurance Agent Information
Agent Name ______________________________ Phone: (_________)_______________________
Livestock Production Information
Herd Size
____Sows
____Beef Cattle
____Dairy Cattle
____Poultry
____Other (specify_____________)
Annual Production
____# of market sold annually ____ # of feeder sold annually
____# of market sold annually ____ # of feeder sold annually
____lbs. of milk sold annually
____# sold annually
____# sold annually
Estimated Annual Revenue
$__________________
$__________________
$__________________
$__________________
$__________________
Current Financial Information
Primary Operating Lender:
Contact Name:
SIGN HERE
Phone:
X
Title
Date
Applicant’s Signature (required) – By signing here you represent that the information provided is accurate and complete, to the best of
your knowledge.
X
Print Name
Date
Primary Owner Signature Individually – Required for Corporation, LLC & Partnerships in addition to the Applicant’s signature above.
X
Date
Co-Applicant’s Signature – If applicable.
John Deere Financial Fax: 1-800-732-0251
Multi-use accounts are a service of John Deere Financial, f.s.b.
CR3910257 Litho in U.S.A. (12-08)
Mail to: John Deere Financial, P.O. Box 5328, Madison, WI 53705
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