Financing

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First Name

Middle Name

Last Name

Address

City

State

Zip Code

Primary Phone

Secondary Phone

SSN/SIN (xxx-xx-xxxx)

Driver's License Number

CDL Years

Date of Birth (yyyy-mm-dd)

Marital Status

Own or Rent Home

How Long at Address (Year/Month)

Former Address,City,State,Zip (if less than 5 years at current)

How Long (Year/Month)

Business Details

Business Name

Business Tax ID

Business Start Date

Business Type

Have you ever filed bankruptcy?

Have you ever filed bankruptcy-explanation?

Are you subject to any tax liens?

Have you ever had a home foreclosure or been evicted?

Are you subject to any tax liens?-explanation?

Have you ever had a home foreclosure or been evicted - explanation?

Have you ever had any item repossessed?

Have you ever had any item repossessed - explanation?

LIST OF HAULING REFERENCES

First & Last Name / Business Name

City/State

Contact Phone

Relationship

First & Last Name / Business Name

City/State

Contact Phone

Relationship

CO-SIGNER INFORMATION

Check this box only if this is a joint application with a co-signer, or if you are relying on a co-signers income or assets as a basis for repayment of the credit requested, or if you reside in a community property state.

First & Last Name

City/State

Contact Phone

Relationship

Co-signer SSN

Co-signer Place of Employment

Co-signer position

How Long (Year/Month)

APPLICANT'S EMPLOYMENT HISTORY

Current Employer

Employer Phone

Position

How Long (Year/Month)

Former Employer

Employer Phone

Position

How Long (Year/Month)

TRUCK OWNERSHIP AND USAGE

Previous Truck/Trailer Owner?

Yes NO

Current #

Previous #

Is the applicant the driver?

Yes NO

Financed/Previously financed vehicles or assets

Business Vehicles Owned 1

Name of Lender

Balance $

Business Vehicles Owned 2

Name of Lender

Balance $

Other Assets 1 (Itemize)

Name of Lender

Balance $

Other Assets 2 (Itemize)

Name of Lender

Balance $

BANK ACCOUNT INFORMATION

Bank Name

City

State/Province

Type of Account(s)

TERMS AND CONDITIONS

Equipment Looking To Be Financed (Can Choose Multiple)

I agree to the Credit Application Agreement and authorize the credit checks it describes.

Signature required

repossessed

repossessed_explanation

applicant_notes

signature_typed

application_language

signature_image

doc_license_front

doc_license_back

doc_cdl

doc_bank_statements

doc_tax_return

doc_other

Financing

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Business Details

LIST OF HAULING REFERENCES

CO-SIGNER INFORMATION

APPLICANT'S EMPLOYMENT HISTORY

TRUCK OWNERSHIP AND USAGE

Financed/Previously financed vehicles or assets

BANK ACCOUNT INFORMATION

TERMS AND CONDITIONS

Inventory

Company

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