Submit the original completed form in hard copy or a facsimile copy to the appropriate county FSA office.
Customers who have established electronic access credentials with USDA may electronically transmit this form to the USDA servicing office, provided that: (1) the customer submitting the form is the only person required to sign the transaction, or (2) the customer has an approved Power of Attorney (Form FSA-211) on file with USDA to sign for other customers for the program and type of transaction represented by this form.
Features for transmitting the form electronically are available to those customers with access credentials only. If you would like to establish online access credentials with USDA, follow the instructions provided at the USDA eForms web site.
Fld Name /
|
Instruction |
2A Name and Address |
Enter the name and address of the creditor, including ZIP code.
|
2B Telephone Number |
Enter the telephone number of the creditor, including Area Code.
|
2C Name of Individual or Authorized Entity Representative |
Enter the name of the individual or authorized entity representative.
|
2D Title of Individual or Authorized Entity Representative |
Enter the title of the authorized entity representative listed in Item 2C. |
2E Signature of Individual or Authorized Entity Representative |
Enter the signature of the individual or authorized entity representative listed in Item 2C.
If you are mailing or faxing this form, print the form and manually enter your signature. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office. |
2F Name of Second Individual or Authorized Entity Representative |
Enter the name of the second individual or authorized entity representative.
|
2G Title of Second Individual or Authorized Entity Representative |
Enter the title of the second authorized entity representative listed in Item 2F. |
2H Signature of Second Individual or Authorized Entity Representative |
Enter the signature of the individual or authorized entity representative listed in Item 2F.
If you are mailing or faxing this form, print the form and manually enter your signature. If this form is approved for electronic transmission and you have established credentials with USDA to submit forms electronically, use the buttons provided on the form for transmitting the form to the USDA servicing office. |
Page
File Type | application/msword |
File Title | Instructions for FSA-441-5 |
Author | Preferred Customer |
Last Modified By | alvin.young |
File Modified | 2005-12-21 |
File Created | 2005-12-21 |