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City SSN/Tax ID State Zip Bus Phone FAX Mobile Phone Ext. M- Married U- Unmarried includes single divorced widowed SP - Separated Are you a n 0 None 1 - Joint Director 2 - FLBA/FLCA Dir. 3 PCA Dir. 4 Farm Credit Bank Dir 5 Farm Credit Admin. Dir. What year did you begin farming Email County Marital Status Birthday Phone Primary Farm Product 6 Assn Employee or Director 7 Bank Employee 8 FCA Employee 9 Relative of Employee 10 ACA Dir. ASSOCIATION / LOCATION ASSN NO. LOAN NUMBER...
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