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Credit Application


ALL FIELDS REQUIRED

APPLICATION TYPE

Partnership

Proprietorship

Corporation

Individual

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#
Address
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 Email Address
 		 Your Title:
 



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