Applicant Information

Applicant Name:

First Name

Last Name

Social Security Number

Birth Date

Home Phone Number

Cell Phone Number

Applicant Email

Number of Dependants

Time at Resident

Present Address

Street Address

Street Address Line 2

City

State

Zip Code

Co-Applicant

Yes

No

Co-Applicant Information

First Name

Last Name

Email

Cell Phone Number

Address

Address Line 1

Address Line 2

City

State

Zip Code

Application Information: Business Entity

Business Name

Federal Tax ID #

Business Address

Address Line 1

Address Line 2

City

State

Zip Code

Business Description

Percentage of Ownership

Principal/Officer Name and Title

Title

Principal/Officer Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Loan and Property Information

Loan Amount

Desired Loan Product

Term (yrs)

Amortization (yrs)

Bare Land Only Value:

Permanent Planting Value (if applicable):

Improvement Value (include outbuildings & residence): $

Projected Loan-to-Value (loan amount/(bare land + permanent plantings)): %

Total Collateral Value: $

Source of Funds

Source of Funds Description

Amount

Source of Funds Total

Use of Funds

Use of Funds Description

Amount

Use of Funds Total

Total Source of funds should equal total use of funds. (Attach additional exhibits or descriptions as needed)

Is this financing related to any recent (12 month or less) land transactions? If so, please describe the terms of the land purchase, including purchase price:

Describe terms of recent land purchase:

General Business Information

Please provide a brief description (size and scope) of your current business operation:

At least one applicant must be a United States citizen or lawfully admitted alien to the U.S. who maintains permanent residence in the U.S. or a coporate entity or partnership whose members, stockholders, or partners holding a majority interest in the corporate entity or partnership are citizens or lawfully admitted aliens. The following list of questions applies to all applicants. Check all that apply.

Have you had a bankruptcy in the past 48 months.

Do you have any judgements against you?

Are you party to a lawsuit?

Have you had a property foreclosed or deed in lieu in the past 48 months?

Are any of the assets pledged as security for debts of others?

Do you have any contingent liabilities?

Have you endorsed or guaranteed notes for others?

Are you obligated to pay alimony or child support?

If Yes to any of the above please provide a written explanation to the for inclusion with this application:

Consolidated Balance Sheet

Financial Statements as of: (MM/DD/YYYY) (Within 90 days of application date is preferred)

Assets/Amount

Cash, Savings, Securities

Accounts Receivable

Crop Inventory

Market Livestock Inventory

Breeding Livestock Inventory

Machinery

Real Estate Market Value

Other

Total Assets

Liabilities/Amount

Operating Debt

Credit Card Debt

Accounts Payable/Trade Debt

Equipment Debt/Vehicle Debt

Long-Term Debt

Other Liabilities

Total Liabilities

Total Assets

Total Liabilities

Total Equity

Consolidated Income Statement

Most Recent Income Statement for Period beginning : (MM/DD/YYYY)

Most Recent Income Statement for Period ending : (MM/DD/YYYY)

Gross Farm Income

Net Farm Income (plus interest and deprciation)

Net Non-Farm Income

Total Net Income: (Net Farm + Net Non Farm)

Do you have a current operating Loan

Yes

No

Current Operating Lender

Years with Lender

Committed LOC Amount

Collateral- Property Information

Property Address

Address Line 1

Address Line 2

City

State

Zip Code

Other:

Land Information

Dryland Tillable Acres

Value per Acre

Total Acre Value

Irrigated Tillable Acres

Value per Acre

Total Acre Value

Pasture Acres

Value per Acre

Total Acre Value

CRP Acres

Value per Acre

Total Acre Value

Permanent Plantings Acres

Value per Acre

Total Acre Value

Timberland Acres

Value per Acre

Total Acre Value

Other/Woods/Waste Acres

Value per Acre

Total Acre Value

Building/Improvements Value

Building/Improvements Total Value

Total Acres

Total Acre Value

Collateral - Irrigation Information

1. Is Your Property Irrigated?

Yes

No

1. Describe any water, irrigation, or well right/restrictions:

2. What is the source of water?

Groundwater/Well

Irrigation District

If Groundwater /well, what is the quantity (gallons per minute) and quality of the water?

3. Is the source located off the property?

Yes

No

If Yes, is a Water Use Agreement in place? (Please describe)

4. Is your property located in an irrigation district?

Yes

No

What is the irrigation district?

5. What percentage of the water supply is provided by the irrigation district and what percentage/cost is supplemented by water exchanges or ground water?

Irrigation District (%)

Supplement (%)

Supplement Cost: $

6. What is the quantity and quality of groundwater?

7. What is the quantity and quality of any exchange water?

8. What is the cost ($/acre foot) for the total water used on the proposed security?

Collateral - Improvements, Lease and Rental Agreement

1. Are there any improvements or permanent plantings on the collateral?

Yes

No

Please provide a description of any improvements and/or plantings:

2. Have any improvements, repairs, or work taken place on the property within the last six months (including any that are currently underway or that will commence shortly)?

Yes

No

If Yes, please explain:

3. Is there a residence on the collateral?

Yes

No

If yes, is this your primary residence?

Yes

No

4. Are there any lease or rental agreements on the property?

Yes

No

If yes, are there any lease or rental agreements for which the remaining term (including any unexercized renewal options or rights) is three years or more?

Yes

No

5. Are there any manure easements, wind leases, cell towers, or other easements or agreements?

Yes

No

Upload any additional collateral and documents necessary for the application.

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Signatures and Authorizations

Signature

Sign Here

Signature

Sign Here

Signature

Sign Here

Signature

Sign Here

I authorize Conterra Ag Capital (“Conterra”) to make whatever inquiries it deems necessary, in its sole discretion, in connection with this credit application and any update, increase, renewal, extension, or collection of the credit extended. I further authorize Conterra to complete, and share with third parties, any information that it may have or obtain in response to such inquires and agree that such information along with this application shall remain Conterra's property, whether credit is extended. All information stated in this application is true and correct. I acknowledge that Conterra is relying on the information contained in this credit application as it relates to its credit decision. I further acknowledge that my credit application is subject to underwriting guidelines and approval, that my submission of this credit application does not constitute an offer to lend by Conterra, and that I may not qualify for credit approval. I HAVE REVIEWED THE ABOVE DISCLOSURE.

I consent to have this website store my submitted information so they can respond to my inquiry

By clicking the submit button you confirm you have reviewed and agree to the above disclosure.

Conterra Ag Premier Application

Applicant Information

Applicant Name:

Co-Applicant Information

Application Information: Business Entity

Loan and Property Information

Source of Funds

Use of Funds

General Business Information

Consolidated Balance Sheet

Assets/Amount

Liabilities/Amount

Consolidated Income Statement

Gross Farm Income

Collateral- Property Information

Land Information

Collateral - Irrigation Information

Collateral - Improvements, Lease and Rental Agreement

Signatures and Authorizations