ADM Credit Application
ADM Archer Daniels Midland Company
CREDIT APPLICATION
Blank Form
ADM Use Only
Co / PC   Account No.  
Location No.  
Submitted By  
To:
ADM Corporate Credit
P.O. Box 1470 Decatur, IL 62525
Tel: (217) 424-5411    Fax: (217) 424-6187
Tuesday, January 16, 2018 8:49:40 PM
Red field labels denote required fields
Company Name:
Address: City:
Country:  
State/Province: Zip:
Phone: Fax:
Fed ID or SS#: Duns No.:
Entity Type: How long in business:
Owner's Information (Partnerships must provide information on all partners)
Owner #1:
First Name: Middle Initial: Last Name:
Social Security#: Date of Birth:
Owner #2:
First Name: Middle Initial: Last Name:
Social Security#: Date of Birth:
Owner #3:
First Name: Middle Initial: Last Name:
Social Security#: Date of Birth:
Owner #4:
First Name: Middle Initial: Last Name:
Social Security#: Date of Birth:
Purchaser's Information
Buyer's Name:
ADM Division: ADM Contact Name:
Accts. Pay Contact: Accts. Pay Phone:
ADM Product(s) Purchased:
Annual Usage (lbs./cwt. etc.): Credit Requested: $
Comments:
Banker's Reference
Bank Name:
Address: City:
Country:  
State: Zip:
Contact: Phone:
Account No.: Fax:
Financial Information (for credit requests >= $25000)
We ask that you consider supplying the financial information options listed below along with the accountant’s opinion letter. All information will be held in strict confidence and used solely for the extension of credit.
Fiscal Year:
Current Assets: $ Retained Earnings: $
Total Assets: $ Operating Profit: $
Current Liabilities: $ Net Income: $
Total Liabilities: $
Current Portion Long Term Debt: $
Comments regarding Loan Covenants
Supplier Reference(s)
Name:
Address: City:
Country:  
State: Zip:
Contact: Phone:



Name:
Address: City:
Country:  
State: Zip:
Contact: Phone:



Name:
Address: City:
Country:  
State: Zip:
Contact: Phone:
**Please mail a current financial statement with a copy of this application. Credit request processing will commence immediately on submitting this e-form
The undersigned hereby authorises any bank or other lender or grantor of credit, to provide Archer Daniels Midland Company (ADM), information regarding the character, reputation, financial responsibility and indebtedness of the undersigned as requested by ADM for the purpose of evaluating the commercial credit request of the undersigned and hereby releases ADM, and any lender or grantor of credit from any and all claims or causes of action that may arise of which be might by reason of information furnished ADM by said bank or other lender or grantor of credit.
The undersigned who is a principal of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents to and authorizes the use of a consumer credit report on the undersigned by the above named business credit grantor, from time to time as may be needed, in the credit evaluation process and in connection with the collection of credit extended as a result of this application.
 
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