Close
Help
Success
Error
Please select your business from the list below
Don't see your business here? Try one of the options in the drop down box or proceed by choosing 'Business Not Listed'.
--Select--
Business search
DBA name search
Business not listed
Ok
Cancel
General Information
Application Amount
$
Credit Limit Requested
$
Existing / Previous Account #
Which product line are you applying to?
FarmTek
Growers Supply
ClearSpan
GrowSpan
Tek Supply
Company Information - For Business Name please provide the DBA name for your Sole Proprietorship
*
Business Name
Doing Business As (DBA Name)
Tax ID
*
Physical Address
*
City
*
State/ Province
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
*
Zip/Postal
Country
United States Of America
Canada
Telephone - Work
Email Address
Legal Structure
Not Available
Sole Proprietorship
Limited Liability Company
Cooperative
Corporation
Nonprofit Corporation
S Corporation
Partnership
Limited Partnership
Type of Business
Year Business Established
Business Website
*
Application Contact Name
Telephone - Work
Application Contact Email Address
Mailing Address
Mailing Address2
City
State/ Province
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Zip/Postal
Are PO's Required (Yes/No)
Annual Sales
Authorized Purchaser Name
Tax Exempt (Yes/No)
Yes -Attach Certificate
No
Tax Exempt/Resale Cert#
Trade Reference Information
Reference Name
Reference Type
Not specified
Trade
Bank
Personal
Reference Account Number
Reference Account Type
Not specified
Checking
Line of Credit
Other
Saving
Credit Card
Reference Account Balance
$
Phone Number
Reference Email
Contact Name
Phone Number
Contact Email
Reference Name
Reference Type
Not specified
Trade
Bank
Personal
Reference Account Number
Reference Account Type
Not specified
Checking
Line of Credit
Other
Saving
Credit Card
Reference Account Balance
$
Phone Number
Reference Email
Contact Name
Phone Number
Contact Email
Reference Name
Reference Type
Not specified
Trade
Bank
Personal
Reference Account Number
Reference Account Type
Not specified
Checking
Line of Credit
Other
Saving
Credit Card
Reference Account Balance
$
Phone Number
Reference Email
Contact Name
Phone Number
Contact Email
Bank Reference Information
Bank Name
Bank Account Number
Bank Account Type
Checking
Savings
Brokerage
Credit Card
Line of Credit
Loan
Lease
Other
Bank Address
Bank City
Bank State/Province
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Bank Zip/Postal
Bank Country
United States Of America
Canada
Bank Contact Name
Bank Contact Phone Number
Bank Contact Email Address
PERSONAL INFORMATION OFFICERS, OWNERS, GUARANTORS
*
Principal Type
Prin
Guar
*
Principal First Name
Principal Middle Name
*
Principal Last Name
*
Principal Home Address
*
City
*
State/ Province
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
*
Zip/Postal
Telephone - Home
Telephone - Work
Principal Email Address
*
Principal Social Security Number (SSN)
Principal Type
Prin
Guar
Principal First Name
Principal Middle Name
Principal Last Name
Principal Home Address
City
State/ Province
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
Zip/Postal
Telephone - Home
Telephone - Work
Principal Email Address
Principal Social Security Number (SSN)
Attachments
If the applicant is tax exempt, upload the following document. Please Note, regardless of your tax exempt status, the Applicant will be required to provide a form of personal identification as sole proprietor. Our Staff will contact you directly to obtain this form of personal identification.
Attachment Description
Attachment Location
Upload
NOTE: You may attach up to 5 attachments with maximum size of 10 megabytes
Terms and Conditions
*
Signature of Applicant
*
Title
*
Date
PRINT AGREEMENT
*
I agree to the terms and conditions specified above.
*
User Verification
Please complete the following by entering the value EXACTLY how it appears(case sensitive)
Why do I have to do this?
Submit
Clear All
Create New Application
Print
false