Page 17 - 2017 Heritage Place Winter Mixed Sale

ALL BUYERS AND PROSPECTIVE BIDDERS
CHECKING ACCOUNT VERIFICATION

THIS FORM MUST BE TURNED IN TO HERITAGE PLACE
AT LEAST ONE WEEK PRIOR TO THE SALE

A: HERITAGE PLACE, INC. Date ______________________________
2829 S. MacArthur Blvd.
Oklahoma City, OK 73128 SS#_______________________________
Driver’s
FROM: License ___________________________

___________________________________________ _____________________________________________

(NAME) (FARM NAME OR EMPLOYER)

___________________________________________ _____________________________________________

(ADDRESS) (ADDRESS)

___________________________________________ _____________________________________________

___________________________________________ _____________________________________________

(TELEPHONE) (TELEPHONE)

Approximate Amount of Purchases _______________________________________

Are you a Licensed Owner or Trainer? Yes No

If Yes, your # is________________________________State ____________________

Trainer’s Name is: ______________________________________________________

To Be The credit applicant whose signature appears below has had an account
Completed By with this bank for _______ years. The average balance of this account
Bank Officer during the past two years has been in the range of _________________

Signed _______________________________________________________
Bank _________________________________________________________
Bank Officer’s Name ___________________________________________
Title __________________________________________________________
Address ______________________________________________________
Telephone________________________ Account No._________________

By signing this account verification, applicant authorizes Heritage Place, Inc., to
perform a credit investigation.
Signature of Applicant___________________________________________________
Subscribed and sworn to before me on this _________________________ day of
___________________________________________________, 20 ________________
NOTARY PUBLIC
_________________________________ COUNTY, __________________________

PAGE 15