BUYER REGISTRATION & CONSENT FORM

North Arkansas Livestock Auction, Inc. #3201

P.O. Box 321

Green Forest, AR 72638

Phone (870) 438-6915 FAX (870) 438-5223

Date: __________________

· BUYER INFORMATION (Please check one)

□ Principal Name: _______________________________________ Business Name: _______________________________ Address: _____________________________________ City: __________________ State: ___ Zip: _________ Phone: ______________________________________ Email: _______________________________________ Social Security Number: ________________________ Driver’s License #: ____________________ State: ___ Are you bonded?: Yes ___ No ___ Amount $________ Occupation: ___________________________________ Estimated amount of purchase: $__________________

□ Buyer Representative Buyers Name: _________________________________ Representing: _________________________________ Address: _____________________________________ City: __________________ State: ___ Zip: _________ Phone: _______________________________________ Email: _______________________________________ Social Security Number: _________________________ Driver’s License #: ____________________ State: ___ Are you bonded?: Yes ___ No ___ Amount $________ Occupation: ___________________________________ Estimated amount of purchase: $__________________

· REFERENCE INFORMATION

Bank Name: _______________________________ Branch Location: ___________________________________

City: _______________________ State: ________________ Telephone: _________________________________

Account Officer: _______________________________ Officer’s Extension or direct # _____________________

(Funds will be paid from the following account)

□ Checking Account Account Number: ______________________________

□ Loan or Line of Credit Account Account Number: ______________________________

I hereby authorize this livestock market, through the LIVESTOCK BOARD OF TRADE, a service division of LIVESTOCK MARKETING ASSOCIATION, to contact my bank for, and authorize my bank to release to LIVESTOCK BOARD OF TRADE, information concerning my business’ financial responsibility. A copy or facsimile of this authorization shall be valid as the original.

Signature: _____________________________________ LBT Fax 816-891-7108