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866.225.8490
13123 48th Ave South, Seattle, WA, 98168
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About
Credit Application
Application Type
*
Partnership
Proprietorship
Nonprofit Org.
Corporation
Corporation Tax ID Number, if applicable
*
Personal Information
(With State + Expiration Date)
Primary Applicant
Age
*
Name
*
License No.
*
No. Dependens
*
Business Phone:
*
Residence Phone
*
Date of Birth
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1900
S.S. Number
*
Spouse
Full Name
*
Age
*
Date of Birth
*
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S.S. Number
*
Fieldset
How long ?
Own/Rent
*
Own
Rent
Present Address
Address Line 1
*
Address Line 2
*
City
*
State
*
Zip
*
Mortgage/Rent Paid To
*
Years
*
Months
*
Former Address
State
*
Address Line 1
*
Address Line 2
*
City
*
Zip
*
Corporation Information
Corporation Name
*
Date Of Incorporation
*
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February
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1901
1900
Date In Business
*
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February
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Federal Tax Id
*
Current number of trucks in operation
*
How many trailers ?
*
Incorporated in what state?
*
Principal
*
Age
*
Principal Title
*
%Owned
*
Principal
*
Age
*
Principal Title
*
%Owned
*
# Owner/Operators
*
Owner
Operators
Have you ever filed Bankruptcy
*
No
Yes
if Yes, When & Why ?
*
Have you ever had any items Repossessed
*
No
Yes
if Yes, When & Why ?
*
Are you involved in any legal actions
*
No
Yes
Do you have any Judgments or Liens
*
No
Yes
Nearest Relatives Not At Above Address
Name
*
Address
*
City
*
State
*
Phone
*
Relation
*
Name
*
Address
*
City
*
State
*
Phone
*
Relation
*
Name
*
Address
*
City
*
State
*
Phone
*
Relation
*
Name
*
Address
*
City
*
State
*
Phone
*
Relation
*
Current Haul/Business contracts
(Materials, Between What Points,
Construction,Over-The-Road, Etc.)
Company Name
*
Contact Name
*
Address
*
Position
*
Phone
*
How long ?
*
Company Name
*
Contact Name
*
Address
*
Position
*
Phone
*
How long ?
*
Company Name
*
Contact Name
*
Address
*
Position
*
Phone
*
How long ?
*
How long as an owner-operator ?
*
Gross Monthly Income
*
Nature Of Business
*
Trade - in Description
Trailer
Truck
Year
*
Make
*
Model
*
Engine
*
Transmission
*
Rears
*
Sleeper
*
Serial Number
*
Condition
*
Good
Fair
Poor
Months In Loan
*
Payment Amount
*
Amount Still Owed
*
Title State
*
Other Info
*
Year
*
Make
*
Model
*
Engine
*
Transmission
*
Rears
*
Sleeper
*
Serial Number
*
Condition
*
Good
Fair
Poor
Months In Loan
*
Payment Amount
*
Amount Still Owed
*
Title State
*
Other Info
*
Purchase Item Description
Year
*
Model
*
Make
*
Truck/Trailer
*
Truck
Trailer
Detailed Description
*
Purchaser's Financial and Current Credit Statement
Examples: How To Fill Out This Section
Include:
Assets - Real Estate, Savings Account, Trucks, Trailers, Autos, Loans
Liabilities - Credit Cards, Fuel Bill, Etc.
Description
*
Bank
*
Phone
*
Actt. No.
*
Asset Value
*
Amount You Owe
*
Payment Amount
*
Description
*
Bank
*
Phone
*
Actt. No.
*
Asset Value
*
Amount You Owe
*
Payment Amount
*
Description
*
Bank
*
Phone
*
Actt. No.
*
Asset Value
*
Amount You Owe
*
Payment Amount
*
Description
*
Bank
*
Phone
*
Actt. No.
*
Asset Value
*
Amount You Owe
*
Payment Amount
*
Description
*
Bank
*
Phone
*
Actt. No.
*
Asset Value
*
Amount You Owe
*
Payment Amount
*
Have you filed bankruptcy in the last 10 years?
*
No
Yes
Any items repossessed?
*
No
Yes
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
*
Select a Month
January
February
March
April
May
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1982
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1935
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1933
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1931
1930
1929
1928
1927
1926
1925
1924
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1922
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1920
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1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Your Title
*
Email
*
Signed By
*
Security
Please draw the shape in the box to submit the form
*
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