TERRA VERDE 2012 SERIES IX SUPPLEMENTAL APPLICATION

(FOR EXISTING ALBERTA PRODUCERS ONLY)

DETAILS SHEET

1. Tillage Equipment: The following changes have been made to the Applicant’s tillage equipment:
[Provide details of changes, insert “none” if no changes were made]:
Producer Name Phone:
Cell:
Contact (if different):
Mailing Address: Fax:
 Other
E-mail Address: Date:
Referred to Terra Verde by: Company Name: Individual Name:

2. This application is made in respect of the following years:
2011 2012 2013 2014

3. The Lands included in this application and the details thereof are set out in the Land Information Details that are supplied or will be supplied as part of this application. Any changes in the included lands are as noted and crop details are included for each of the applicable years. For any lands not yet seeded, the Producer shall provide pertinent details for each applicable year once the seeding details are available.

Land Information Details

Name: (full business or corp. name, if applicable) Phone:
Contact (if different): Cell:
Mailing Address: Fax:
E-mail Address: Date:

INCLUDE ALL LAND OWNED OR RENTED

2011

By accepting below and submitting this application, the producer named herein agrees that in submitting this form electronically to be bound by all of the terms and conditions, representations and warranties contained in Terms and Conditions (pointing them to that on that same page of the website). The producer further represents and agrees that it is the Producer named in the Application and Contract and has full right and authority to make this application for inclusion in the Terra Verde contract and unconditionally agrees to be bound by all terms in the Application and Contract.

I agree.
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