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> Credit Application
Credit Application
COMPANY INFORMATION
Company (Legal Name)
Address
City
State
Zip
Contact
Title
Email Address
Telephone
Fax
Nature of Business
Tax ID #
License #
No.Years in Business
Type of Business
Proprietorship
Partnership
LLC
Corporation
Non-Profit
PERSONAL INFORMATION Officers/Partners/Guarantors
1) Name
Title
SS No.
Own %
Spouse
Phone
Cell
Address
City
State
Zip
2) Name
Title
Own %
Spouse
Phone
Address
City
Zip
COMPANY BANK REFERENCE – Two Year History
Name of Bank/Branch
How Long?
Telephone No.
Checking Acct. No.
Contact Officer
Name of Bank/Branch
How Long?
Telephone No.
Checking Acct. No.
Contact Officer
LEASE / LOAN REFERENCES
Lender
Acct. No.
Telephone No.
Contact
Amount Paid
Lender
Acct. No.
Loan Amount
Telephone No.
Contact
Amount Paid
TRADE REFERENCES
Supplier
Phone
Contact/Acct #
Supplier
Phone
Contact/Acct #
Supplier
Phone
Contact/Acct #
EQUIPMENT/VENDOR INFORMATION
Equipment Description
Equipment Cost $
Lease Term (months)
New (year)
Used (year)
Vendor Name
Address
Contact
Telephone
DECLARATION AGREEMENT
By signing below or submitting electronically, the undersigned individual, who is either a principle credit applicant or a guarantor of its obligations, provides this written instruction to TruckLenders, its nominees or assigns, authorizing review of his/her personal credit and financial information on all business principles requested as part of said investigation Such authorization shall extend to obtaining a credit profile in consideration of this application and subsequently for the purpose of update, renewal or the extension of such credit or additional credit and for reviewing and collecting the resulting account. A photostat or facsimile copy of this authorization shall be valid as the original. We affirm our identity as the respective individuals in the related application. We authorize TruckLenders, its nominees or assigns, to file any UCC Filings appropriate. All duplicates are to be viewed as valid as the original.
Signature & Title
Date
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