Land Contract Guarantee program and Emergency Equine Loss Loan (EM) Program - Direct Loan Making

FSA-2005 Date of Modification: (03-22-2010)

CREDITOR LIST
INSTRUCTIONS FOR PREPARATION
Purpose: This form is used to gather creditor information from applicants.
Handbook Reference: 3-FLP, 4-FLP, 5-FLP and 6-FLP	Number of Copies: Original
Signatures Required: Applicant
Distribution of Copies: Original to case file
Automation-Related Transactions: (Instructions for writers: provide only the information required, i.e. ADPS TC 3K. If no automation actions are required, insert N/A) FBP

Applicants must complete all Items.

Fld Name / Item No.	Instruction
A	Instructions to Applicant
1 Name	Enter the applicant’s name.
B	Creditors (Creditors include any bank, credit card company, individual, supplier, etc. to whom the applicant owes money.)
1A Name and Address	Enter the creditor’s name and address.
1B Telephone Number	Enter the creditor’s telephone number (including area code).
1C Account Number	Enter the complete account number for this credit account.
1D Contact Person	Enter the contact person for this creditor (if known).
2A Name and Address	Enter the creditor’s name and address.
2B Telephone Number	Enter the creditor’s telephone number (including area code).
2C Account Number	Enter the complete account number for this credit account.
2D Contact Person	Enter the contact person for this creditor (if known).
3A Name and Address	Enter the creditor’s name and address.
3B Telephone Number	Enter the creditor’s telephone number (including area code).
3C Account Number	Enter the complete account number for this credit account.
3D Contact Person	Enter the contact person for this creditor (if known).
4A Name and Address	Enter the creditor’s name and address.
4B Telephone Number	Enter the creditor’s telephone number (including area code).
4C Account Number	Enter the complete account number for this credit account.
4D Contact Person	Enter the contact person for this creditor (if known).
5A Name and Address	Enter the creditor’s name and address.
5B Telephone Number	Enter the creditor’s telephone number (including area code).
5C Account Number	Enter the complete account number for this credit account.
5D Contact Person	Enter the contact person for this creditor (if known).
6A Name and Address	Enter the creditor’s name and address.
6B Telephone Number	Enter the creditor’s telephone number (including area code).
6C Account Number	Enter the complete account number for this credit account.
6D Contact Person	Enter the contact person for this creditor (if known).
7A Name and Address	Enter the creditor’s name and address.
7B Telephone Number	Enter the creditor’s telephone number (including area code).
7C Account Number	Enter the complete account number for this credit account.
7D Contact Person	Enter the contact person for this creditor (if known).
8A Name and Address	Enter the creditor’s name and address.
8B Telephone Number	Enter the creditor’s telephone number (including area code).
8C Account Number	Enter the complete account number for this credit account.
8D Contact Person	Enter the contact person for this creditor (if known).
9A Name and Address	Enter the creditor’s name and address.
9B Telephone Number	Enter the creditor’s telephone number (including area code).
9C Account Number	Enter the complete account number for this credit account.
9D Contact Person	Enter the contact person for this creditor (if known).
C	Signature
1 Signature	Enter the applicant’s signature.
2 Date	Enter the date the applicant signed the form.

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