(620) 431-6070

M-F 7:30 am - 5:30 pm | Sat 8 am - 4 pm | Sun Closed

2103 South Santa Fe, Chanute, KS 66720

Business Credit Application

Apply for a Cleaver Farm & Home Business Charge Account

If your company would like to establish a charge account with Cleaver Farm & Home, please complete the application below. Our team will review your information, contact references as needed, and follow up once a decision has been made.

Submitting an application does not guarantee approval. All accounts are subject to review, credit checks, and verification of bank and trade references.

First Name *

Last Name *

Business Name *

Phone *

Office Phone

Fax:

Email *

Address

Street Address *

City *

State *

Country

Postal Code *

Form of Business *

Sales Tax # *

Taxpayer ID # *

Owner 1 | Name & Address *

Owner 2 | Name & Address *

Owner 3 | Name & Address *

Type of Business *

Number of years in business *

Previous Year Gross Sales *

$

Current Year Sales to Date *

$

Average Annual Sales *

$

Creditor 1 | Name, Address, Phone, Fax *

Creditor 2 | Name, Address, Phone, Fax *

Creditor 3 | Name, Address, Phone, Fax *

Creditor 4 | Name, Address, Phone, Fax *

Bank Reference 1 | Name, Address, Phone, Bank Officer's Name *

Bank Reference 2 | Name, Address, Phone, Bank Officer's Name *

Trade Reference 1 | Name, Address, Phone, Fax *

Trade Reference 2 | Name, Address, Phone, Fax *

Trade Reference 3 | Name, Address, Phone, Fax *

Trade Reference 4 | Name, Address, Phone, Fax *

I hereby authorize the bank and trade references in this credit application to release the information necessary to assist Cleaver Farm and Home in establishing a line of credit.

Signature *

Clear

Date: *

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out.

By checking this box, I consent to receive marketing and promotional messages, including special offers, discounts, new product updates among others. Message frequency may vary. Message & Data rates may apply. Reply HELP for help or STOP to opt-out.

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