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Credit Application

ALL FIELDS REQUIRED

APPLICATION TYPE
Partnership Proprietorship Corporation Year Incorporated if applicable:
Select the location nearest you

Truck interested in-Stock #: New Used

APPLICANT DATA
Primary Applicant Full Name   
Company Name (if Partnership or Corp.)
License #
Date of Birth Age
SSN or Federal Tax ID
Phone (work)
Phone (home)
Present Address
City-State-Zip

CO-BUYER  INFORMATION
Co-Buyer Full Name
License Number
Date of Birth
SSN
Address
City - State - Zip
Phone (home)
Phone (work)
Years at Present Address

2 NEAREST RELATIVES NOT AT ABOVE ADDRESS
Name Address City State Zip Phone Relation

BRIEF DESCRIPTION OF OPERATIONS

INSURANCE INFORMATION
 Insurance Co. Name (Liability and Physical Damage)
Agent

HAULING REFERENCES/MAJOR CUSTOMERS
1
Company Name
Contact / Phone Number Ph#
Address
How Long
2
Company Name
Contact / Phone Number Ph#
Address
 How Long 
3
Company Name
Contact / Phone Number Ph#
 How Long 

CURRENT FLEET DATA
# of Tractors   Where Financed  
# of Trailers   Where Financed  
# of Trucks   Where Financed  

CREDIT REFERENCES
Reference Name Phone # Acct # Contact

SIGN AND DATE
The information given above is true and complete. Lender may receive from and disclose to other persons, including credit reporting agencies, information about Applicant's accounts and credit experience and Applicant authorizes any person to release to Lender credit experience and account information on Applicant. This shall be a continuing authorization for all present and future disclosures of account information and credit experience on Applicant made by Lender or any person requested to release such information to Lender.
Today's Date
 Signed By:
 

Your E-Mail Address
 		 Your Title: