Customer ApplicationCustomer Application • February 27th, 2020
Contract Type FiledFebruary 27th, 2020Names(s) Individual or full legal name of corporation, partnership or other legal entity Date Contact Title (if legal entity) CCAN# Email Address Section A Address Phone number Mobile phone number City State County Zip code Fax number Billing name Same as above Attention Title Billing address City State Zip code Phone number SECTION B Individual/Sole proprietorship General partnership* Limited liability company (board managed)* Corporation*Other Limited partnership* Limited liability company (member managed – no board)*If corporation, partnership, or LLC attach either articles of incorporation, partnership agreement, or LLC articles of organization. If corporation or LLC, also include bylaws, operating agreement or similar organizational document. If Other, include applicable formation/organizational document(s) State of Organization Date of Organization Briefly describe operation Year Began Farming (Producer) Federal Tax ID number (or Social Security number, if individual) SECTION