Credit Application

Please fill out this secure credit application. If you use Auto Fill feature, please double check entries closely. Once submitted, our representative will contact you.

PERSONAL INFORMATION
First Name
Middle Initial
Last Name
Suffix
Address
City
County
State/Province
ZIP/Postal Code
Primary Phone
 - 
Secondary Phone
 - 
Email Address
SSN/SIN (xxx-xx-xxxx)
CDL No.
CDL Years
Date of Birth (mm/dd/yyyy)
Marital Status
No. of Dependents
Own or Rent Home
How Long at Address (Year/Month)
 / 
Years in Area
Former Address,City,State,Zip (if less than 5 years at current)
How Long (Year/Month)
 / 
BUSINESS INFORMATION
Business Type
Have you ever taken bankruptcy?
Are you subject to any tax liens?
Have you ever had a home foreclosure or been evicted?
Have you ever had any item repossessed?
Explain any 'Yes' answer (Less than 200 characters):
LIST OF REFERENCES
First & Last Name
City/State(Province)
 / 
Contact Phone
 - 
Relationship
First & Last Name
City/State(Province)
 / 
Contact Phone
 - 
Relationship
SPOUSE INFORMATION
 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.
APPLICANT'S EMPLOYMENT HISTORY
Current Employer
Employer Phone
 - 
Position
How Long (Year/Month)
 / 
Immediate Past Employer
Employer Phone
 - 
Position
How Long (Year/Month)
 / 
TRUCK OWNERSHIP AND USAGE
Primary Haul Source (Do not list own company)
Company
City
State/Province
Contact
Phone Number
 - 
Previous Truck/Trailer Owner?
Is the applicant the driver?
BALANCE SHEET
Personal Vehicles Owned 1
Value $
Name of Lender
Balance $
Personal Vehicles Owned 2
Value $
Name of Lender
Balance $
Other Assets 1 (Itemize)
Value $
Other Debts (Itemize)
Balance $
Other Assets 2 (Itemize)
Value $
Other Debts (Itemize)
Balance $
BANK ACCOUNT INFORMATION
Bank Name
City
State/Province
CREDIT APPLICATION AGREEMENT
(Click to view/hide the agreement)