WESTCO Agricultural Credit Application & Agreement

All fields are required to fully complete application.

After completing application, please email a photocopy of the applicant's state driver's license to credit@westco.coop. If applicant elects to receive Patronage Dividends, please download the IRS W-9 form below, and email to credit@westco.coop. 

W-9

WESTCO Credit Terms

I have read and agree to the Credit Terms above.
Consent *	No Yes
General Information
Account Name *
Applicant Name (First, MI, Last) *
Mailing Address: *
City *
Zip Code *
State *
Cell Phone *
Home Phone
Email *
Applicant S.S.N.: *
Spouse's S.S.N.:
EIN/Fed. Tax ID: *
Applicant D.O.B: *
Spouse's D.O.B:
Operation Info
Years in Operation: *
Acres in Operation *
Acres Owned: *
Acres Rented: *
Description of Operation
Crops:
Livestock:
Other:
Credit Information
Financing: *	Operation Self-Financed/No Borrowing Borrowing of Operating Funds
Bank: *
Bank Phone #: *
Loan Officer:
Loan Officer Phone/email:
Supplier Ref. 1: *
Ref. 1 Phone: *
Supplier Ref. 2: *
Ref. 2 Phone: *
Will you need propane services? *	No Yes
If Yes: Tank Selection	Lease WESTCO Tank Purchase WESTCO Tank Own My Tank
WESTCO Charge Cards are only needed if you plan to use your WESTCO Account at our C-Stores or 24-hour fuel locations. All charges will go under one account; however, on your statement you can see the card number of the purchaser, giving you the ability to split our charges if needed.
Will you need WESTCO charge cards? *	Yes No
Total cards needed:
Cards w/ same #/pin:
Cards w/ diff. #/pin:
Credit Authorization
The information provided on this application is correct and complete. I hereby authorize Western Cooperative Company (DBA WESTCO) to conduct a credit investigation, including contact of my bank reference to support information I have provided. I also agree to abide by WESTCO's credit terms, which I have reviewed:
eSignature: *
Date: *
Personal Guarantor Signature: *
Date: *
Patronage Dividends
As a patron of Western Cooperative Company, I hereby consent and agree that the amount of any distributions with respect to patronage occurring on or after Oct. 1, 1963, which are made in written notices of allocation as defined in 26 U.S.C. 1388, and I receive from the Cooperative, will be into my accounts at their stated dollar amount in a manner provided in 26 U.S.C 1385(a) in the taxable year in which I receive such written notices of allocation. ** Receiving Patronage is optional. If receiving patronage, please sign. This will require you to submit a completed W-9 Form, which can be found on this page and emailed to credit@westco.coop.
eSignature:
Date:
Credit accounts bill under 30-day terms
* Required field

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