| COMPANY INFORMATION | |||
| COMPANY NAME |
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| FIRST NAME |
LAST NAME |
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| MAILING ADDRESS |
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| CITY |
TOWN |
POSTAL CODE |
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| WORK PHONE |
WORK FAX |
CELL |
|
| EMAIL |
WEBSITE |
ALTERNATIVE |
|
| COMPANY IS BONDED BY THE CANADIAN GRAIN COMMISSION? | □ YES | □ NO | |
| LIVESTOCK and GRAIN INFORMATION | ||
| LIVESTOCK FED (cattle, hogs, poultry, etc.) |
AVERAGE MONTHLY CAPACITY |
AVERAGE MONTHLY TONNAGE FED |
| TYPE OF GRAIN FED
(barley, wheat, peas, oats, hulless barley, pellets, etc.) |
||
| DESCRIBE ANY
PREMIUMS OR DISCOUNTS APPLIED TO OFF-SPEC GRAIN |
||
| DO YOU HAVE YOUR
OWN TRUCKS OR PREFERRED HAULERS? DESCRIBE ANY EQUIPMENT. |
||
| DO YOU HAVE A SCALE
ON-SITE OR DESCRIBE NEAREST LOCATION OF SCALE. |
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| REFERENCES (Grain and/or other related industry, minimum 3) | |||
| COMPANY | CONTACT | PHONE | FAX |
| FINANCIAL INSTITUTIONS (Minimum 1) | ||||
| BANK | CONTACT | PHONE | FAX | ACCOUNT # |
| MEMBERSHIP | |
| □ Yes, please sign me up for a membership. Enclosed is a cheque for $115.50 for the year. | Below is my preferred password: |
|
I authorize the above references and any credit agency to disclose full financial information concerning myself (proprietorship/partnership) and the operations of the company listed. This information is given in confidence and will be used exclusively by Market Master Ltd. in administration of my account. I believe the company listed above is financially able to payment commitments and will issue payment for grain (direct to the seller/producer/hauler) within 10 days. |
|
| DATE | Make cheque payable to: Market Master Ltd. 8543 - 75 Avenue Edmonton, Alberta T6C 0G9 |
| SIGNATURE | |