Bill's Tractor
Agricredit Acceptance LLC	Application for Credit
For what dealer or location are you submitting this application?
List tractor and/or equipment being considered
Applicant's name (First, Middle, Last)
Your Social Security #
Date of Birth
Have you ever used AAC before?	No
Current physical address of residence (no PO box)
City
State / Province
Zip / Postal code
County
Home telephone number
Work or cell telephone number
Marital status	Married    Unmarried   Separated
Years at current address
E-mail address
Name of nearest relative not living with you
Relationship
City
State / Province
Telephone number
Type of business	Individual
Equipment use	Farm
County and State/Province in which  equipment will be kept
Employer
City, State/Province
Years
Annual gross income
Source of other income
Frequency and amount
Do you farm?	Part time
Number of acres owned
Number of acres rented
Have you had any unsatisfied judgments rendered against you in the past 7 years, had equipment repossessed in the past 7 years, or been declared bankrupt in the past 10 years?	No Yes
Submit this application IF 1) this equipment is for FARM or CONSUMER use, AND 2) this application amount PLUS all existing debt payable to Agricredit is LESS THAN $50,000 Applicant: (1) affirms that the information provided in this application, including the reverse side if completed, is true and correct and given for the purpose of obtaining credit; (2) understands that if credit is extended, Agricredit Acceptance LLC, it's agents, servicers, affiliates and assigns ("AAC Entities"), will rely on such information to secure the indebtedness; (3) authorizes references to provide all relevant information to the AAC Entities; (4) authorizes the AAC Entities to investigate and obtain reports concerning credit history; and (5) authorizes the AAC Entities to release to, and share and exchange with : (a) any other AAC Entities, (b) any manufacturer of any equipment covered by this application, and (c) any dealer who may sell or lease any of the equipment covered by this application or who may submit or originate this application, any information concerning Applicant or Applicant's credit experience with the AAC Entities and their decision whether or not to extend any credit. Applicant waives any right to confidentiality that may exist with respect to the release, exchange or sharing of such information. The AAC Entities are authorized to retain any information obtained as part of the application process whether or not the requested credit is granted.
BILL'S TRACTOR 10865 Hwy 87S Adkins, Texas 78101 phone 210 649 1715 fax 210 649 1777	By submitting this application, I/we certify that everything stated in this Application is true to the best of my/our knowledge and I/we agree with all the terms stated above.
Date