Buyer Registration & Consent Form
Winner Livestock Auction - #3656
PO Box 611 ~ Winner, SD 57580
Phone: 605.842.0451 ~ Fax: 605.842.3562
Buyer Information
Person Responsible for Payment	Buyer Representative
Name: _____________________________	Buyers Name: _____________________
Business Name: _____________________	Representing: ______________________
Address: ___________________________	Address: __________________________
City: __________ State:____ Zip: _______	City: ___________ State: ___ Zip: ______
Phone #: ___________________________	Phone #: ___________________________
Fax #: _____________________________	Fax #: _____________________________
Email: _____________________________	Email: _____________________________
Are you bonded: Yes __ No __ Amount _________	Are you bonded: Yes __ No __ Amount _________
Occupation: ________________________	Occupation: ________________________
Estimated Amount Purchase: ___________	Estimated Amount Purchased: __________
Responsible Party Information
Bank Name: ________________________	Branch Location: ____________________
City: _______________ State: __________	Telephone #: ________________________
Account Officer: ____________________	Officer’s Ext. or Direct #: _____________
(Funds will be paid from the following account)
____ Checking ____ Loan or Line of Credit
I hereby authorize this livestock market, through the LIVESTOCK BOARD OF TRADE
(LBT), a service division of LIVESTOCK MARKETING ASSOCIATION, to contact
My bank for, and authorize my bank to release to LIVESTOCK BOARD OF TRADE,
Information concerning my business’ financial responsibility and, from time to time, to
Update that information. Although I am aware that electronic transmission of information
To LBT by mail, email, telephone or fax, as requested by LBT. A copy or facsimile of
This authorization shall be as valid as the original.
Signature: ________________________________________________________