Name of supplier ..............................................
Address .......................................................
SSN/TIN .......................................................
Date notification statement was prepared ......................
Name of lender ................................................
Address .......................................................
Name of person to whom lender's response to supplier should be addressed .....................................................
Address .......................................................
Description and anticipated date of the application of agricultural chemicals ........................................
Anticipated charges for the agricultural chemicals ............
Anticipated charges for application, if not included in charges for chemicals .................................................
Name of grower ................................................
Address .......................................................
SSN/TIN .......................................................
Reasonable description of the real estate where the agricultural chemicals are to be applied ......................
................................................................
Name of owner of real property (if other than grower) ........
................................................................
Address .......................................................
Crops growing or to be grown on such real property as to which the supplier intends to supply agricultural chemicals and upon which supplier intends to obtain a security interest ..........
................................................................
Signature of supplier .........................................
Signature of grower ...........................................
Name of lender ................................................
Address .......................................................
Lender responds to notification statement as follows (choose one):
[] An outstanding commitment for operating financing exists for
this grower. Of that commitment, lender hereby reserves the amount specified in the notification statement for the purpose of honoring drafts or other demands for payment by supplier, accompanied by invoices signed by grower or other proof of delivery signed by grower.
[] Lender hereby subordinates the priority of its security
interest in (specify crops) .................... of grower to the priority of the security interest in such crops obtained or to be obtained by supplier, such subordination to be in the amount specified in the notification statement.
[] Lender declines to either reserve funds or subordinate its
security interest.
Signature of lender ...........................................
Idaho Code § 28-9-322A