Request to Bid on Load Lots
(Load Lot)
Buyer Information
(check one please)
Principal
(if no business name leave blank)
Buyer Representative
(representing the Business Name below)
Name:
Business Name:
Address1:
Address2:
City:
State:
Zip:
( 000-000-0000 )
Phone#:
Email:
( 000-00-0000 )
Social Security#:
Driver's License#
:
(check just one)
Are you bonded:
YES
NO Amount $
Occupation:
Estimated Amount of Purchase: $
Reference Information
Bank Name:
Branch Location:
( 000-000-0000 )
City:
State:
Zip:
Telephone:
Account Officer:
Officer's Extension or Direct#:
( Funds will be paid from the following account(s) )
Checking Account Account Number:
Loan or Line of Credit Account Account Number:
Comments:
Choose User Name and Password Below
User Name:
Password:
_______________________________________________________________________________________________________
I hereby authorize this livestock market, through the LIVESTOCK BOARD OF TRADE (LBT), a service division of LIVESTOCK MARKETING ASSOCIATION, to contact my bank for, and authorize my bank to release to LBT, information concerning my business' financial responsibility and, from time to time, to update that information. Although I am aware that electronic transmission of information over a public network is not secure, I nevertheless authorize my bank to provide this information to LBT by mail, email, telephone or fax, as requested by LBT. A copy or facsimile or electronic submitted form of the authorization shall be as valid as the original.
X______________________________________
Signature:
IF BOX CHECKED, I AGREE WITH THE ABOVE STATEMENT AND AUTHORIZE LBT TO PROCESS THIS REQUEST
(IF YOU DO NOT AGREE WITH THE ABOVE STATEMENT / DO NOT CLICK SUBMIT / JUST CLOSE THE FORM / THANK YOU)