Credit Application Form Company InformationCompany Name First Federal Tax ID Contact Name MC/DOT# Phone Number Annual Revenue Fax Number Corporation Type Email Address Year Started Address Street Address Suit City State / Province / Region ZIP / Postal Code Number of Units in the FleetTractors Trailers Light / Medium Duty Equipment to Purchase InformationYear Purchase Price Make Dealer Model Dealer Contact Name Odometer Dealer Contact Number Bank InformationBank Name Checking Average Bank Balance Savings Hauling / Equipment Financing ReferencesHauling Reference Company Name How Many Years Equipment Finance Reference Products Hauled Personal Guarantor InformationName Social Security DOB Percentage OwnedRentHomeownerAddress Street Address Suit City State / Province / Region ZIP / Postal Code Name Social Security DOB Percentage OwnedRentHomeownerAddress Street Address Suit City State / Province / Region ZIP / Postal Code DISCLAIMER: By signing below, I 1) certify that the information above is true and correct, 2) certify that any assignee, lending or funding partner that may be involved in the funding process to obtain and verify all credit information in the above provided, including but not limited to bank references, hauling references, and personal credit. 3) I understand that individual credit history may factor into the application decision based on credit worthiness and authorize to review all personal credit, 4) I waive any right or claim I would otherwise have under the Fair Credit Reporting Act in the absence of this continuing consent, 5) I certify that this request is for commercial (business) and not personal (consumer) use. Additionally, this authorization permits any assignee, lending or funding partner that may be involved to share and exchange information and to request, obtain and review bank, financial, or other information from past, present or potential creditors. SignatureTitle Date MM slash DD slash YYYY SignatureTitle Date MM slash DD slash YYYY
