FSA-441-18 Consent to Payment of Proceeds from Sale of Products

FORMS MANUAL INSERT

FORM FSA-441-18

Used in Uniform Commercial
Code States to obtain an
agreement as to the amount
of proceeds from sale of farm
products to be paid to FSA.

(SEE REVERSE)

PROCEDURE FOR PREPARATION

:

FSA Transferred Instruction 1941-A, FSA Handbook 3-FLP.

PREPARED BY

:

Agency Official.

NUMBER OF COPIES

:

Original and two copies.

SIGNATURE REQUIRED

:

Agency Official, Borrower and the Purchaser.

DISTRIBUTION OF COPIES

:

Original in the County Office; copy to the Borrower and Purchaser.

(12-08-04) FSA PN Issue No. 215

FMI Page 1

FORMS MANUAL INSERT

FORM FSA-441-18

INSTRUCTIONS FOR PREPARATION
Borrower must complete Items 2 through 8B. Purchaser must complete
Items 10A through 10C.
Item 1 is for FSA use only.
Fld Name /
Item No.
1
County FSA
Office
Name,
Address,
and
Telephone
Number

Instruction
Enter County FSA Office name, address, Zip Code, and telephone
number including Area Code.

Items 2 through 8B are completed by the Borrower.
Fld Name /
Item No.
2
Seller or
Borrower
Name,
Address,
and
Telephone
Number
3
Purchaser’s
Name,
Address,
and
Telephone
Number
4
Effective
Date of This
Consent
5
Names of
Product(s)
Purchased

Instruction
Enter seller or borrower name, address, Zip Code, and telephone
number including Area Code.

Enter purchaser’s name, address, and telephone number including Area
Code.

Enter the effective date of this consent or assignment. (MM-DDYYYY)

Enter the kind of product(s) purchased.

(12-08-04) FSA PN Issue No. 215

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FORMS MANUAL INSERT
Fld Name /
Item No.
6(a)
Amount of
Purchase
Price
6(b)
Percent of
Purchase
Price
6(c)
Payment
Schedule
7(a)
Payment to
FSA
7(b)
Joint
Payment
7(c)
Bank
Payment
8A
Borrower's
Signature
8B
Date

FORM FSA-441-18
Instruction

Enter a dollar portion of the purchase price or the full purchase price if
less than that amount.

Enter the percentage of the purchase price figured to the nearest dollar,
payable in either case.

Enter the payment schedule as monthly, bimonthly, or other.

Enter a check in the box if payable to the order of the Farm Service
Agency.
Enter a check in the box if payable jointly to the order of the borrower
and the Farm Service Agency.
Enter a check in the box if payable to the order of the bank and include
the name, address, and Zip Code of the bank.
Enter the seller or borrower signature.

Enter the date form signed by seller or borrower. (MM-DD-YYYY)

Items 9A through 9C for FSA only.
Fld Name /
Item No.
9A
FSA
Authorized
Signature

Instruction
Enter the FSA authorized signature.

(12-08-04) FSA PN Issue No. 215

FMI Page 3

FORMS MANUAL INSERT

Fld Name /
Item No.
9B
Title
9C
Date

FORM FSA-441-18

Instruction
Enter the title of the FSA Authorized Agency Official.
Enter the date form signed by the FSA Authorized Agency Official.
(MM-DD-YYYY)

Items 10A through 10C are completed by the Purchaser.
10A
Purchaser or
Duly
Authorized
Officer
Signature
10B
Title of the
Purchaser
10C
Date

Enter the signature of the purchaser or the duly authorized officer.

Enter the title of the purchaser or the duly authorized officer.

Enter the date form signed by purchaser or duly authorized officer.
(MM-DD-YYYY)

(12-08-04) FSA PN Issue No. 215

FMI Page 4