Application for Credit

Submit an application for credit with Envision Cooperative. You may also download the application form (PDF, 883.70 KB), print it out, fill it in, and then mail it to:

Envision Cooperative
105 4th Ave SW
Rugby, ND 58368-1033

Submit Your Information

Fields marked (*) are required.

Personal Information
    1. While not required, if you do not enter your SSN, you will need to provide your number to us via phone in order to complete the application process.
  1. Are you married? *
Employment Information
  1. Are you a farmer? *

If you answered yes to the previous question, please enter the following information.

  1. Do you own the farm?
  2. Type of farming
Bank Information
  1. Type of account *
Credit References
  1. Type of account *
  2. Status of account *
  3. Type of account
  4. Status of account
  5. Type of account
  6. Status of account
Account Information
  1. Are you applying for your own separate account? *
  2. Is this account one which your spouse may use? *
  3. Will your spouse be liable for this account? *

If you answered yes to either question regarding your spouse, please enter the following information.

W-9 Information

Please enter your federal identification number. This number plus your personal information above will be used for the Individual Consent and Substitute Federal Form W-9.

Statment of Credit Terms for Envision Cooperative of Rubgy, Towner, Wolford, and Leeds

Dear Patron,

As your elected Board of Directors, we attempt to provide the best services and quality products to our patrons at competitive prices. One of these services has been convenient credit to qualified patrons.Therefore we, as your Board of Directors, in consideration and fairness to all patrons and for the continued success of your cooperative have unanimously adopted the following credit policy.

1.) If you are presently keeping your account current, thank you. This statement is merely informational as it pertains to your cooperative's current credit policy. We thank you for your cooperation and ask for your continued support.

2.) The closing date of the billing cycle will be the last day of the month. All accounts not paid by the 15th of the month following will be placed on a cash basis.

3.) Those accounts not paid in full will be assessed a service or late payment charge beginning on the first of the month at 1.75% of the unpaid balance, which is equivalent to 21% annually.

4.) Advance payments are encouraged and are to be used for goods and services only. Interest rates can vary each month and will closely follow the cooperatives advance pay interest rates.. The maximum allowable advance payment is 1.5 times your annual purchase.

5.) There will be a cash discount on bulk petroleum and bulk propane, if paid within 5 days of delivery. Cash discounts will be allowed from advance pay accounts. Delivery amounts of or greater than 150 gallons of fuel and 200 gallons of propane are required to receive cash discounts.

6.) All fertilizer and chemicals will be cash or paid for in advance. Exception to this is prearranged financing through the manager or credit supervisor with available in-house or third party financing.

7.) We wish to extend every reasonable opportunity to our patrons to comply with this new credit policy. Patrons who do not have their accounts current may be placed on a cash basis or a credit limit may be established for an amount in which the patron can stay within our terms.

We sincerely believe these policy changes are in the best interest to you, as patrons, as well as your cooperative and its future.

Sincerely,

Envision Board of Directors

Wayne Slaubaugh, President, Andy Fedje, Vice President, Marie Marshall, Secretary, R' Jay Paul, Director, Scott Johnson, Director, Joe Schmaltz, Director, Brad Fritel, Director.

Revolving Charge Credit Agreement

In consideration of the extension of credit by this cooperative (Seller), the undersigned (Buyer) agrees as follows:

1.) That the closing date of the billing cycle will be the last day of the month and that accounts should be paid upon receipt of the periodic statement.

2.) That if the amount for which credit is extended is not received before the next closing date, a finance charge will be assessed on the past due balance. The past due balance will be computed by deducting all current payments and credits from the previous balance. The finance charge will be computed by applying a periodic rate of 1 3/4% per month which is equivalent to an annual percentage rate of 21%.

3.) That if the amount for which credit is extended is received before the next closing date, a finance charge will not be assessed. The Buyer shall have the privilege of paying such amount in installments or in full at any time.

4.) That if the Buyer pays in installments, the minimum amount due and payable before the next closing date is the total of: (a) fifty percent (50%) of the amount for which credit was extended for purchases made in or services performed during the billing cycle ended on the most recent closing date; (b) the entire amount remaining unpaid from any previous billing cycle; plus, (c) the finance charge, if any, computed in accordance with the provisions of paragraph two (2).

5.) That if the Buyer fails to pay the minimum amount due and payable, Seller may declare Buyer’s entire unpaid balance due and payable. If payment is not received and account is sent for collection by a third party, then all collections cost will be added to the existing bill.

Signature for Individual Consent (for W-9), Credit Application, and Revolving Charge Credit Agreement

Your signature below asserts that:

1.) (for Individual Consent & Substitute Federal Form W-9) I hereby consent to include in my gross income, as now or hereafter provided in the federal income tax laws, the stated dollar amount of each written notice of allocation which I receive from Envision with respect to my patronage occurring during the current and all subsequent taxable years of this cooperative. This individual consent shall be revocable by me at any time if in writing.

Certification: Under penalties of perjury, I certify that:

[1] The number I entered on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and [2] I am not subject to backup withholding either because I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the IRS has notified me that I am no longer subject to backup withholding.

2.) (for application consideration) The above information is for the purpose of obtaining credit and is warranted to be true. I or we agree to pay all bills upon receipt of statement or as otherwise expressly agreed.

I or we hereby authorize the person or firm to whom this application is made to investigate the references herein listed or from any other person pertaining to my credit and financial responsibility (spouse must sign if contractually liable).

3.) (for Revolving Charge Credit Agreement) Buyer hereby acknowledges receipt of a copy of this agreement and agrees to its terms and conditions.