Forms - GEC

Membership Application

Please read the boxes below carefully and only check those that apply.

Class "A" Membership Applicant Class "B" Membership Applicant Providing Information ONLY, no membership

The undersigned does hereby agree to purchase from Gold-Eagle Cooperative one membership unit. If the Class “A” box above is checked, the undersigned will receive one $500 par value Class “A” common stock for the subscription cost of $25. The remaining $475 may be earned by future patronage allocations relating directly to Gold-Eagle Cooperative earnings and the applicant’s volume of business with GoldEagle Cooperative. If the Class “B” box above is checked, the undersigned will receive one $25 par value Class “B” membership unit.

The undersigned understands that as a Class “A” stockholder the undersigned will be eligible to hold a board position, but will not be eligible to hold an officer position on the board until the Class “A” common stock of $500 has be fully paid or earned. The undersigned understands that as a Class “B” stockholder, the undersigned will not be eligible to vote in Gold-Eagle Cooperative elections and/or special votes or hold a board position of any kind.

The Board cannot consider a member application unless payment is sent to PO Box 168 - Eagle Grove, IA 50533.

First Name

Last Name

Phone

Street Address

City

State

Zip Code

Date of Birth

Social Security Number

Signature

Date

Under penalty of perjury, I certify by typing my name as my signature above, that (1) the number shown on this form is my correct taxpayer number (or I am waiting for a number to be issued to me) and (2) I am not subject to backup withholding because (A) I am exempt from backup withholding or (B) I have not been notified by the IRS that I am subject to backup withholding as a result of failure to report all interest or dividends or (C) the IRS has not notified me that I am no longer subject to a backup withholding.

Business Credit Application Forms

ACH Authorization Application

Account Name

Phone

Street Address

City

State

Zip Code

Bank Name

Bank Address

Bank Routing Number

Bank Account Number

Bank Contact Person

Bank Phone

Applicant Signature

Date

By typing my name as my signature above, I hereby authorize Gold-Eagle Cooperative to initiate ACH CREDIT AND/OR DEBIT entries to the customer’s checking account indicated above, and also authorizes the financial institution named above to ACH CREDIT AND/OR DEBIT such entries to the customer’s account. This authorization shall remain in effect until terminated upon 30 days written notice by either the company or Gold-Eagle Cooperative.

LP Account Application Form

Company Name (INDIVIDUALS DO NOT HAVE TO COMPLETE THIS SECTION)

Company Net Worth

Address

City

State

Zip Code

Company Phone

EIN or TIN Number

Primary Applicant First Name

Middle Name

Primary Applicant Last Name

Primary Applicant Title (If Applicable)

Primary Applicant Email

Primary Applicant Home Phone

Primary Applicant Cell Phone

Primary Applicant Street Address

Primary Applicant City

Primary Applicant State

Primary Applicant Zip Code

Primary's Social Security Number

Primary's Date of Birth

Primary's Marital Status

Co-Applicant First Name

Middle Name

Co-Applicant Last Name

Co-Applicant Title (if applicable)

Co-Applicant Street Address

Co-Applicant Email

Co-Applicant Home Phone

Co-Applicant Cell Phone

Co-Applicant City

Co-Applicant State

Co-Applicant Zip Code

Co-Applicant Social Security Number

Co-Applicant Date of Birth

Co-Applicant Marital Status

Primary Bank

Bank Branch

Bank Phone

Annual Income

The undersigned applicant and co-applicant agree that the following terms will govern any purchases made which are charged to any open charge account that applicant and/or co-applicant may have with Gold-Eagle Cooperative (GEC)
#1. Balance due in full by the 15th of the month, following the month of purchase.
#2. An unpaid balance will be assessed a finance charge of 1.5%, which is an APR of 18% per year starting on the 16th day of the month (this rate is subject to change with notice on the monthly statement).
#3. Payments shall be first applied to the unpaid finance charge and the remainder to the unpaid balance.
#4. In the event collection action becomes necessary to collect on the account, any and all costs incurred by, including collection service payments, court costs, and attorney fees will be applied to the outstanding account balance.
#5. If applying for a joint account, both applicant and co-applicant agree to be bound by the terms of this agreement, and each agrees to be jointly and severally liable for payment of all purchases made under this agreement.
#6. GEC shall have the right to limit or terminate this charge account, but the limitation or termination shall not affect the obligation to pay an existing account balance. Upon termination, GEC may at its option declare the entire balance due and payable immediately.

This document authorizes the release of any and all of applicants’ and/or co-applicant’s financial information to gec board members, management, legal advisors, and accountants, and releases gec as the custodian of such records, both individually and collectively, from any and all liability for damages which may result due to release of this information pursuant to this authorization. The undersigned further authorizes gec to obtain business credit reports from credit bureaus or other credit partners and share any and all information in their care, custody, and control concerning the undersigned applicant and/or co-applicant as well as any information received pursuant to this authorization. The undersigned applicant and co-applicant hereby releases gec and from any and all liability for damages of which may result due to the release of this information pursuant to this authorization. It is expressly agreed that a photocopy or email of this authorization shall be as valid as an original.

Primary Applicant Signature

Date

Co-Applicant Signature

Date

Fuel Card Application Form

This fuel card account application (the "application") relates to fuel card and miscellaneous Merchandise ONLY. If approved, short-term credit will be extended by and can be utilized by applicant solely for fuel card and misc. Merchandise purposes. Gold-Eagle Cooperative is not a finance company and expects prompt on-time payment for outstanding balances.

PRIMARY APPLICANT FULL LEGAL NAME (FIRST, MIDDLE, LAST)

PRIMARY APPLICANT TITLE (IF APPLICABLE)

PRIMARY APPLICANT ADDRESS

PRIMARY APPLICANT CITY

PRIMARY APPLICANT STATE

PRIMARY APPLICANT ZIP CODE

PRIMARY APPLICANT HOME PHONE

PRIMARY APPLICANT MOBILE PHONE

PRIMARY APPLICANT EMAIL ADDRESS

PRIMARY APPLICANT SOCIAL SECURITY NUMBER

PRIMARY APPLICANT DATE OF BIRTH

PRIMARY APPLICANT MARITAL STATUS (REQUIRED FOR SOLE PROPRIETORSHIP)

CO-APPLICANT FULL LEGAL NAME (FIRST, MIDDLE, LAST)

CO-APPLICANT TITLE (IF APPLICABLE)

CO-APPLICANT ADDRESS

CO-APPLICANT CITY

CO-APPLICANT STATE

CO-APPLICANT ZIP CODE

CO-APPLICANT HOME PHONE

CO-APPLICANT MOBILE PHONE

CO-APPLICANT EMAIL ADDRESS

CO-APPLICANT SOCIAL SECURITY NUMBER

CO-APPLICANT DATE OF BIRTH

CO-APPLICANT MARITAL STATUS (REQUIRED FOR SOLE PROPRIETORSHIP)

Primary Bank (Including Branch)

Primary Bank Phone Number

Annual Income

I AGREE THAT THE FOLLOWING TERMS WILL GOVERN ANY PURCHASES MADE WHICH ARE CHARGED TO ANY GAS CHARGE ACCOUNT THAT I MAY HAVE WITH GOLD-EAGLE COOPERATIVE “GEC”.

1. BALANCE DUE IN FULL BY THE 15TH OF THE MONTH FOLLOWING MONTH OF PURCHASE. WE WILL NOT CHARGE INTEREST ON YOUR PURCHASES IF YOU PAY YOUR ENTIRE BALANCE BY THE DUE DATE EACH MONTH.
2. UNPAID BALANCE WILL BE ASSESSED A FINANCE CHARGE OF 1.5%, WHICH IS AN APR OF 18% PER YEAR STARTING ON THE 16TH OF THE MONTH (THIS RATE IS SUBJECT TO CHANGE WITH NOTICE ON THE MONTHLY STATEMENT).
3. PAYMENTS SHALL BE FIRST APPLIED TO THE UNPAID FINANCE CHARGE AND THE REMAINING TO THE UNPAID BALANCE.
4. IN THE EVENT COLLECTION ACTION BECOMES NECESSARY TO COLLECT ON YOUR ACCOUNT, ANY AND ALL COSTS INCURRED BY, INCLUDING COLLECTION SERVICE PAYMENTS, COURT COSTS, AND ATTORNEY FEES WILL BE APPLIED TO YOUR ACCOUNT.
5. IF APPLYING FOR A JOINT ACCOUNT, BOTH OF THE UNDERSIGNED APPLICANTS AGREE TO BE BOUND BY THE TERMS OF THIS AGREEMENT AND EACH OF US AGREE TO BE JOINTLY AND SEVERALLY LIABLE FOR PAYMENT OF ALL PURCHASES, INTEREST, AND COSTS OF COLLECTION, PURSUANT TO THIS AGREEMENT.
6. GEC SHALL HAVE THE RIGHT TO LIMIT OR TERMINATE MY GAS CARD CHARGE ACCOUNT, BUT TERMINATION SHALL NOT AFFECT APPLICANT’S OBLIGATION TO PAY AN EXISTING BALANCE. UPON DEFAULT OF PAYMENTS, GEC MAY DECLARE THE ENTIRE BALANCE DUE AND PAYABLE IMMEDIATELY.

THIS DOCUMENT AUTHORIZES THE RELEASE OF ANY AND ALL OF APPLICANT’S AND/OR CO-APPLICANT’S FINANCIAL INFORMATION TO GEC BOARD MEMBERS, MANAGEMENT, LEGAL ADVISORS, AND ACCOUNTANTS, AND RELEASES GEC AS THE CUSTODIAN OF SUCH RECORDS, BOTH INDIVIDUALLY AND COLLECTIVELY, FROM ANY AND ALL LIABILITY FOR DAMAGES WHICH MAY RESULT DUE TO RELEASE OF THIS INFORMATION PURSUANT TO THIS AUTHORIZATION. THE UNDERSIGNED FURTHER AUTHORIZES GEC TO OBTAIN CONSUMER CREDIT REPORTS FROM CREDIT BUREAUS OR PARTNER CREDIT AGENCIES AND SHARE ANY AND ALL INFORMATION IN THEIR CARE, CUSTODY, AND CONTROL CONCERNING THE UNDERSIGNED APPLICANT AND/OR CO-APPLICANT AS WELL AS ANY INFORMATION RECEIVED PURSUANT TO THIS AUTHORIZATION. THIS AUTHORIZATION IS VALID FOR 180 DAYS. THE UNDERSIGNED ACKNOWLEDGES RECEIPT OF CREDIT CARD APPLICATION DISCLOSURE STATEMENT. IT IS EXPRESSLY AGREED THAT A PHOTOCOPY OF THIS AUTHORIZATION SHALL BE AS VALID AS AN ORIGINAL.

Primary Applicant Signature

Date

Co-Applicant Signature

Date

Grain Direct Deposit Application Form

Will grain checks be deposited into a checking or savings account?

Checking Savings

Banking Routing Number (9 digits)

Banking Account Number

**Physical checks can still be written in place of direct deposit should you wish to pick one up. Simply alert the grain department when you sell that you would like a check instead. This action will not void this form.
**Funds transferred via direct deposit may take one or two days to be available in your account.
**Holidays/bank holidays will result in a delay of transfer of two regularly scheduled business days. I hereby authorize Gold-Eagle Cooperative (GEC) to directly deposit my grain checks into the bank account listed above. This authorization is to remain in force until/unless GEC has received written notice from me of its termination or change. Also, I hereby grant GEC the right to correct any such electronic funds transfer resulting from an erroneous overpayment by debiting my account to the extent of such overpayment.

Email Address (to receive settlement documentation)

Account(s) to be Affected (Oakland #)

Signature

Date

Career Interest Form

Scholarship Application

Scholarships applications are open from January 1 to April 1.

Gold-Eagle Cooperative is offering four $500 scholarships to graduating seniors in Faribault (MN), Hancock, Humboldt, Kossuth, Winnebago, and/or Wright counties pursuing an ag degree or trade beginning the following academic year. Applicants must be a Gold-Eagle member, a dependent of a member, or the dependent of a full-time employee. Funds will be distributed following receipt showing proof of successful completion of one semester’s coursework.

Instructions for Application

The deadline for application submission is April 1. Any applications received after this date will be considered on a funds available basis.
Attach a current copy of your high school transcripts.
Two signed letters of recommendation (from non-relatives) must be attached to this application.
Choose one of the following topics for a 500 word essay.
1. Explain the global impact of Iowa agriculture.
2. What role does agriculture play in your local county?
3. What makes a cooperative different from a corporation?
Please include an introductory paragraph about yourself and why you should be considered for the scholarship (not included in the 500 word requirement).

Consideration for this scholarship award will be based on GPA, participation in extra-curricular activities, school organizations, community service, letters of recommendation, and grammar/content of the essay. This scholarship will not be awarded to any student who receives a scholarship which sufficiently finances all tuition, fees, and books during the student’s initial year of study.

To submit your application, gather the documents requested and choose ONE of the following options:

1. Online Form

2. Email Files

3. Physical Copies

Donation Request

Primary Contact First Name

Primary Contact Last Name

Organization Name

Primary Contact Title/Affiliation

Are you a 501 (C) 3?

Yes No

EIN Number

Phone

Mailing Address

Project Title

Amount Requested

When are the Funds Needed?

Brief Overview of Campaign/Event (Please include date, time, details, etc.)

What will the funds support?

How will this benefit our community?

Is there an opportunity for a press release, advertising or social media posting?

If your campaign/event has a promotional flyer, please upload it so it can be reviewed with your request.

Add an Authorized User to Your Talon Portal

Account Holder First Name

Account Holder Last Name

Account Holder Email

Account Holder Phone

Date of Change

Customer Account Number

1) First Name

1) Last Name

1) Phone

1) Association with Account Holder (Spouse, Bookkeeper, Child, etc.)

1) Email

2) First Name

2) Last Name

2) Phone

2) Association with Account Holder (Spouse, Bookkeeper, Child, etc.)

2) Email

3) First Name

3) Last Name

3) Phone

3) Association with Account Holder (Spouse, Bookkeeper, Child, etc.)

3) Email

I, hereby state that I authorize the above people access to my Gold-Eagle Cooperative account, including access to the online Customer Portal, Talon, which can include:
• Visibility of Account Balances, Statements, Invoices, Payment History and Purchase History;
• Quote Requests and the Purchasing of Products;
• Cash Bids for Grain, including ability to make offers;
• Contracts for products such as Propane, Fuel, Agronomy applications and Grain Sales;
• Energy Tank info and Service request capabilities;
• The ability to Make a Payment; and
• Communication with Gold-Eagle Cooperative team members through email and/or phone.

This contract will remain in effect until and unless otherwise noted by the account holder via written notice or until this date:

Signature of account holder

Date

All GEC Forms in One Place

Forms & Applications

Contact Form

Membership Application

Business Credit Application Forms

ACH Authorization Application

LP Account Application Form

Fuel Card Application Form

Grain Direct Deposit Application Form

Career Interest Form

Scholarship Application

Instructions for Application

1. Online Form

2. Email Files

3. Physical Copies

Donation Request

Add an Authorized User to Your Talon Portal

Talon Sign-Up Form

Newsletter Sign Up Form

All GEC Forms in One Place

Forms & Applications

Contact Form

Membership Application

Business Credit Application Forms

ACH Authorization Application

LP Account Application Form

Fuel Card Application Form

Grain Direct Deposit Application Form

Career Interest Form

Scholarship Application

Instructions for Application

1. Online Form

2. Email Files

3. Physical Copies

Donation Request

Add an Authorized User to Your Talon Portal

Talon Sign-Up Form​

Newsletter Sign Up Form

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