Credit Application
APPLICATION
TYPE
Partnership
Proprietorship
Nonprofit Org
Corporation
Corporation Tax ID Number, if applicable
PERSONAL INFORMATION
Primary
Applicant
Full Name:
License
No:
State :
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Expiration:
/
/
Date Of Birth:
/
/
S.S. Number:
Business Phone:
Residence Phone:
# Dependents
Spouse
Full Name:
Date Of Birth:
/
/
S.S. Number:
Present
Address
Address Line 1:
Address Line 2:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
ZIP:
How long?:
Own/Rent
Mortgage/Rent Paid
To $
Former
Address
Address Line 1
Address Line 2
City
State
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
ZIP
CORPORATION INFORMATION
Corporation Name
Incorporated in what
state?
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Date Of Incorporation
/
/
Date In Business
/
/
Principal Age
Principal Title
Principal Age
Principal Title
NEAREST RELATIVES
NOT AT ABOVE ADDRESS
Name
Address
City
State
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Phone
Relation
EMPLOYMENT -
PAST & PRESENT - FIVE YEARS
Company Name
Contact Name
Address
Position
Company Name
Contact Name
Address
Position
How long as an owner-operator?
Nature Of Business
Gross Monthly Income
TRADE-IN DESCRIPTION
Truck
Year
Make
Model
Engine
Transmission
Rears
Sleeper
Serial Number
Condition
Title State
Months In Loan
Payment Amount
Amount Still Owed
Other
Info
Trailer
Year
Make
Model
Length
Width
Height
Serial Number
Condition
Title State
Months In Loan
Payment Amount
Amount Still Owed
Other
Info
PURCHASER'S FINANCIAL & CURRENT
CREDIT STATEMENT
Examples:
How To Fill Out This Section
Assets - Real Estate, Savings
Account, Trucks, Trailers, Autos, Loans
Liabilities - Credit Cards,
Fuel Bill, Etc.
Description:
Savings
Acct.
Checking Acct.
Bank:
Phone:
Acct. No.
Asset Value
Payment Amount
Amount You Owe
Description
Savings Acct.
Checking
Acct.
Bank
Phone
Acct. No.
Asset Value
Payment Amount
Amount You Owe
Have you filed bankruptcy
in the last 10 years?
Any items repossessed?
SIGN & 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 Title
Your email Address