Credit Application

 Tuesday, January 06, 2009
Purchase Information

Are you currently working with a Sales Associate?

If yes, please state their name:

Which truck would you like to buy?

How much would you like to put down?

How many months would you like to pay:
Personal Information

First Name:

Middle Initial:

Last Name:

Social Security No.:

CDL No.:

Date of Birth:

No. of Dependents:

E-mail Address:

Area Code & Phone:

Cell Phone or Pager Number:

Address:

City:

State:

Zip Code:

How Long At Address:

years

How Long In Area:

years

Mortgage Company/Landlord Name:

Area Code & Phone Number:

Former Address:

(if less than five years)

City:

State:

Zip Code:

How Long:

Business Name:

(for titling purposes, if applicable)

Business Tax ID No.:

Business Address:

(if different from above)

City:

State:

Zip Code:

Business Area Code & Phone:
Your Nearest Relatives Not Living With You

1. Name:

Relationship:

City:

State:

Area Code & Phone:

2. Name:

Relationship:

City:

State:

Area Code & Phone:
Financial Questions

Have You Ever Taken Bankruptcy?

If Yes, please explain:

Are You Subject To Any Tax Liens?

If Yes, please explain:

Are You A Defendant In Any Legal Action?

If Yes, please explain:

Have You Ever Had Any Item Repossessed?

If Yes, please explain:
Spouse Information
Complete this section only if this is a joint application with your spouse, or if you are relying on your spouse's income or assets as a basis for repayment of the credit requested, or if you reside in a community property state.

First Name:

Middle Initial:

Last Name:

Date of Birth:

Social Security Number:

Employer:

Position Held:

How Long:
Your Spouse's Nearest Relatives Not Living With You

1. Name:

Relationship:

City:

State:

Area Code & Phone:

2. Name:

Relationship:

City:

State:

Area Code & Phone:
Employment History for the Past Five Years (Present or Last Employer First)

Name of Company:

Area Code &Phone:

Position Held:

How Long:

Name of Company:

Area Code &Phone:

Position Held:

How Long:

Name of Company:

Area Code &Phone:

Position Held:

How Long:
Truck Ownership and Usage

Previous Truck Owner?

How Many?

Financed?

If Financed, Name & City of Lender (most recent):

Name: City:

Purchaser To Drive?

If no, complete section below about person who will drive.

Truck to Work For:

Company Name:

Company City:

Company State:

Contact:

Area Code & Phone:

Additional haul:

(If Applicable)

Company Name:

Company City:

Company State:

Contact:

Area Code & Phone:
Driver Information, If Different from Applicant

First Name:

Middle Initial:

Last Name:

Address:

City:

State:

Zip Code:

Social Security Number:

Area Code & Phone:

CDL No.:

Previous Employer:

Company Name:

Area Code & Phone:
Credit References

1. Company Name:

City:

State:

Area Code & Phone:

Account Number:

2. Company Name:

City:

State:

Area Code & Phone:

Account Number:

3. Company Name:

City:

State:

Area Code & Phone:

Account Number:
Bank Account Information

Name:

City:

State:

Area Code & Phone:

Account No.:
SIGNATURES / AUTHORIZATION
The information given is true and complete. Transport Funding (or its agents) 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 Transport Funding (or its agents) 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 Transport Funding (or its agents), or any person requested to release such information to Transport Funding (or its agents). A credit report bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living may be requested in connection with this application. Upon your request Transport Funding (or its agents) will advise you whether a credit report was requested and if such a report was requested, we will inform you of the name and address of the credit reporting agency that furnished the report.

Applicant Name

Guarantor/Co-Borrower Name

 

Fields with red borders are required.