(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

Personal Credit Application

Apply for a Cleaver Farm & Home Personal Charge Account

If you’re interested in opening a personal charge account for use at Cleaver Farm & Home, please fill out the application below. Once submitted, our accounting team will review your information, verify references, and reach out with next steps.

Submitting an application does not guarantee approval. All accounts are subject to credit review and may require a signed Account Agreement and Personal Guarantee.

First Name *

Last Name *

Phone *

Email *

Address

Street Address *

City *

State *

Country

Postal Code *

Social Security # *

Major Creditor 1 | Name, Address, Phone, Fax *

Major Creditor 1 | Secured? *

Major Creditor 1 | Highest Amount Owed *

$

Major Creditor 2 | Name, Address, Phone, Fax *

Major Creditor 2 | Secured? *

Major Creditor 2 | Highest Amount Owed *

$

Major Creditor 3 | Name, Address, Phone, Fax *

Major Creditor 3 | Secured? *

Major Creditor 3 | Highest Amount Owed *

$

Major Creditor 4 | Name, Address, Phone, Fax *

Major Creditor 4 | Secured? *

Major Creditor 4 | Highest Amount Owed *

$

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

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

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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