GRAIN PAYMENT REQUEST

Grain Solutions Advisor or Office Manager:

Date:

Date

Customer Name:

Account #:

Phone Number:

Please enter a valid phone number.Format: (000) 000-0000.

Receive an email receipt of this submission?

Email:

Payment Options:

Auto-Payment of all grain delivered, excluding unsold Delayed Price (DP), Condo and Deferred/Hold Settlements. This selection will remain in effect until a new Grain Payment request form has been submitted.

Auto-Payment of all Full/Filled grain contracts. This selection will remain in effect until a new Grain Payment request form has been submitted.

A one-time payment for all eligible sold grain. This selection is for those who had not previously selected one of the Auto-Pay options noted above. A new payment request form will need to be completed for any future grain payments.

Auto-Payment by paper check paid each Wednesday of all grain delivered, excluding unsold Delayed Price (DP), Condo and Deferred/Hold Settlements. This selection will remain in effect until a new Grain Payment request form has been submitted.

A one-time payment for customers who wish to be paid for specific item(s). This selection is for those who had not previously selected one of the Auto-Pay options noted above. Payments can be requested for specific Contract, Scale Ticket, Bushel or Payment Amount. A new payment request form will need to be completed for any future grain payments.

A payment option for customers who wish to defer payment for specific item(s) to a future date. Payments can be requested for specific Contract, Scale Ticket, Bushel or Payment Amount. A new payment request form will need to be completed for any future grain payments. Deferred payments are eligible for the deferred payment program.

A payment option for customers who wish to hold pay for specific item(s) to a future date. Payments can be requested for a specific Contract, Scale Ticket, Bushel or Payment Amount. A new payment request form will need to be completed for any future grain payments. Hold Pay bushels are not eligible for the deferred payment program.

Crop:

Payment Request:

Payment Details: