Truck Country | Credit Application


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Credit Application

Feel free to print this form out and fax or phone it to us if you would prefer not to submit it electronically.

Truck Country
10703 Route 61 South; PO Box 693
Dubuque, Ia 52004-0693

Phone# 800-553-3642
Fax# 563-582-3828

Truck Country Credit Application

* These Fields MUST be filled in before processing the form.

Interested in:

Salesperson you are working with:

Purchaser’s Full Name*

D.O.B.*

Drivers Lic#

State

Exp. Date

SS#*

Present Address*

City*

State*

Zip*

Home Phone*

E-Mail

At Current Address for: Yr Mo

Rent Own

Mortgagor or Landlord Name/Addr/Phone:

Spouse Name

D.O.B.

SS#

IF A CORPORATION

Partnership

Sole Proprietership

Corporation

Company Name

Date Incorporated

State

Principal Owner

SS#

Tax ID

Business Address*

City*

State*

Zip*

Business Phone*

Business Fax

NEAREST RELATIVE (Not at the above address)

Name

Phone

Relationship

Address

City

State

Zip

TRUCKING EXPERIENCE

Materials Hauled

Radius

Income

# of Years in Trucking

# of Trucks Owned

# of Trailers Owned

EMPLOYMENT (Last 5 Years)

Future Employer

Phone

Contact

City

State

Zip

How Long? Yr Mo

Current Employer

Phone

Contact

City

State

Zip

How Long? Yr Mo

Previous Employer

Phone

Contact

City

State

Zip

How Long? Yr Mo

FINANCIAL HISTORY

Any Reposessions? Yes No

If Yes, When?

Bankruptcy? Yes No

If Yes, When?

BANK REFERENCE AND CONTACT PERSON

Checking and Savings

Bank:

Location:

Account#:

Contact:

Phone:

Loans

Bank:

Location:

Account#:

Contact:

Phone:

PRIMARY CREDIT REFERENCES

#	Installment Loans: Equipment, Trucks, Autos, Business Loans -No Credit Cards This area must be completed!

Name:

City:

State:

Contact:

Phone:

Account#:

Name:

City:

State:

Contact:

Phone:

Account#:

Name:

City:

State:

Contact:

Phone:

Account#:

Date

For the purposes of procuring and maintaining credit, the undersigned submits the foregoing statement and information, ncluding any supplemental sheets, as being true and correct statement of my/our financial condition on the date stated. The undersigned agrees to notify us immediately in writing of any unfavorable change in financial condition.

We hereby grant permission to all above creditors to release our account information. This shall be a continuing authorization for all present and future disclosures to account information and credit experience.