JDC

Applicant’s Signature

Title (For Corporations, Partnerships, and LLC’s)

Co-Applicant’s Signature

Title (For Corporations, Partnerships, and LLC’s)

DCCF3008 Litho in U.S.A. (03-01)

Page 1 of 2

FINANCIAL STATEMENT

FOR AGRICULTURAL & COMMERCIAL

USE OF EQUIPMENT

APPLICANTS LEGAL NAME

Are you a U.S. citizen? Yes No

FIRST

MIDDLE INITIAL

LAST

SOC.SEC. OR TAX ID#

CURRENT STREET ADDRESS (personal residence address for individual applicants)

CITY

STATE

ZIP CODE

COUNTY

YEARS AT CURRENT ADDRESS BUSINESS TELEPHONE NO. HOME TELEPHONE NO. INDIVIDUAL’S DATE OF BIRTH YEARS IN FARMING (OR BUSINESS)

E-MAIL ADDRESS: _______________________________________________________

BUSINESS STRUCTURE

Proprietorship

General Partnership*

Limited Partnership*

Corporation

Limited Liability Company

Trust

State of organization if Corporation, Limited Liability Company or Limited Partnership _______________________________________

State of chief executive office if general partnership ____________________________________________________________________

Organization identification number (if known) ________________________________________________________________________

Equipment purchased for:

Ag Use

Commercial Use Is the equipment purchased for custom use:

Yes

Major Crops:__________________________________________________________________________________________________

Major Livestock: _______________________________________________________________________________________________

* Application must be signed by General Partner

CO-APPLICANTS’ NAME

Are you a U.S. citizen? Yes No

(Individual Co-Applicant required on Partnership, Corporations & LLC Loans)

FIRST

MIDDLE INITIAL

LAST

SOC.SEC. OR TAX ID#

STREET ADDRESS

CITY

STATE

ZIP CODE

TELEPHONE NO.

FINANCIAL INFORMATION

NOTE:	Attach complete Balance Sheet dated within the last 18 months if total John Deere Credit debt exceeds $250,000.
	Attach Income Statement (or Tax Return) for most recent year-end if total JDC debt exceeds $650,000.

Total Assets:			$_____________		Total Liabilities:	$_____________
Gross Annual Farm and Business Income:		$_____________			Gross Annual Other Income:**	$_____________

** Alimony, child support, or separate maintenance need not be disclosed unless relied upon for credit.

Have you ever filed bankruptcy: Yes

Current judgments against you: Yes No

Do you have Farmers Home Administration Loans: Yes

Business Loan References:

CREDITOR NAME

CITY/STATE

CONTACT PERSON

TELEPHONE NO.

The applicant acknowledge(s) that (1) Seller has not misrepresented that the terms of any financing obtained is more or less favorable than other financing; (2) Seller is not applicant’s agent in obtaining the financing; (3) Applicant may obtain financing from other sources; and (4) Seller may be compensated by John Deere.

For the purposes of obtaining credit, I (we) certify to Deere & Company and Deere Credit, Inc. (collectively referred to as “John Deere”) that all information in this statement is true and correct and accurately describes my (our0 financial condition as of date shown, and that there has been no material changes since then. I (we) grant permission to John Deere to verify all information in this statement and to provide any information requested by my (our) other creditors. I also grant John Deere permission to obtain a credit report on me in connection with this transaction and future transactions for all legitimate purposes. Such purposes include assisting in making a credit decision, reviewing my account, and assisting in taking collection activity. I (we) also grant permission to those creditors to provide all information requested by John Deere. I (we) also authorize John Deere to share all the foregoing information with its affiliates. I (we) release and waive all claims against John Deere and my (our) other creditors for all acts or omissions which occur in verifying the above information. See reverse side for important notices.