Fill and Sign the Section 28 9 322aidaho State Legislature Form

Name and address of Supplier Organization or Individual Last NameCity Address Middle Name First Name StateZip Code SSN / TIN Name and address of Lender Organization or Individual Last Name City Address Middle Name First Name StateZip Code Organization or Individual Last Name City Address Middle Name First Name StateZip Code Name and address of person to whom Lender’s response to the Supplier should be addressed Description of application of agricultural chemicals Anticipated date of application Name and address of Grower Organization or Individual Last Name City Address Middle Name First Name StateZip Code Reasonable description of real estate where the agricultural chemicals are to be applied Name and address of Owner of real property (if other than Grower) Organization or Individual Last Name City Address Middle Name First Name StateZip Code Crops growing or to be grown on such real property as to which the supplier intends to supply agricultural chemicals and upon which supplier intends to obtain a security interest Signature of Supplier Signature of GrowerDate Notification Statement was prepared: SECURITY INTERESTS IN IDAHO CROPS FOR PROVISION OF AGRICULTURAL CHEMICALS - FORM AC-1 Anticipated charges for agricultural chemicals Anticipated charges for application (if not included in charges for chemicals) $ $ Idaho Code § 28-9-322A Name and address of Lender Organization or Individual Last NameCity Address Middle Name First Name StateZip Code Lender responds to notification statement as follows (choose one): An outstanding commitment for operating financing exists for this grower. Of that commitment, lender hereby reserves the amount specified in the notification statement for the purpose of honoring drafts or other demands for payment by supplier, accompanied by invoices signed by grower or other proof of delivery signed by grower. Lender hereby subordinates the priority of its security interest in (specify crops) ______________________________ of grower to the priority of the security interest in such crops obtained or to be obtained by supplier, such subordination to be in the amount specified in the notification statement. Lender declines to either reserve funds or subordinate its security interest. Signature of lender Date SECURITY INTERESTS IN IDAHO CROPS FOR PROVISION OF AGRICULTURAL CHEMICALS - FORM AC-1 LENDER’S LETTER OF RESPONSE Idaho Code § 28-9-322A