Credit Application

BUSINESS INFORMATION

LEGAL BUSINESS NAME *

BUSINESS ADDRESS *

Apartment, suite, floor etc

City

State/Province

ZIP / Postal Code

Country

PHONE *

EMAIL ADDRESS *

TYPE OF BUSINESS *

FEDERAL TAX ID

NUMBER OF YEARS UNDER CURRENT OWNERSHIP *

BUSINESS OWNERSHIP

TITLE

FIRST NAME *

LAST NAME *

HOME ADDRESS

Floor/Suite

City *

State/Province *

ZIP / Postal Code

Country *

PHONE *

EMAIL ADDRESS *

SOCIAL SECURITY #

PERCENTAGE (%) OF OWNERSHIP *

2ND OWNER/GUARANTOR'S NAME

SOCIAL SECURITY #

ADDRESS

Do any of the applicants have a commerical drivers license (CDL)? *YesNo

Is at least one of the applicants a US Citizen? *YesNo

If you are a trucking company how many other commerical units do you have if any? *

EQUIPMENT

Vendor

Contact Person

Phone

Vendor's Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Amount ($) *

Available Down Payment if needed ($) *

Type of Equipment *

Equipment Type *NewUsed

Equipment Description and Comments (Year/ Make/Model Helpful if possible):

Additional comments regarding this transaction that you would like us to know about:

By submitting this form, I, the undersigned, acknowledge that my personal credit history may be considered in the evaluation of the applicant's creditworthiness. I hereby consent to and authorize the named business credit provider, its assignees, lenders, or funding services to obtain and use my consumer credit report as needed for credit evaluation and review purposes. I understand that this consent allows them to access my credit report on an ongoing basis and I waive any rights or claims I may have under the Fair Credit Reporting Act in the absence of this consent.

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BUSINESS INFORMATION

BUSINESS OWNERSHIP

EQUIPMENT