Truck Credit App - Truck Country

Interested In
- New
- Used
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Salesperson you are working with
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Purchaser Present Information
Full Name
Birth Date
Drivers Lic. Number
State
Exp. Date
Address
City
State
Zip Code
Soc. Sec. #
Phone
Email
At Current Address for
Year
Month
- Rent
- Own
Spouse Name
Birth Date
Soc. Sec. #

If a Corporation
- N/A
- Partnership
- Sole Proprietorship
- Corporation
Company Name
Date Incorporated
State
Principal Owner
Tax ID
Business Address
City
State
Zip
Business Phone
Business Fax

Trucking Experience
Materials Hauled
Radius
Year
Income
# of Years in Trucking
# of Trucks Owned
# of Trailers Owned
# of Years as Owner/Operator

Employment (Last 5 Years)
Future Employer
Company
How Long?
How Long?
Contact
Phone
City
State
Zip
Current Employer
Company
How Long?
How Long?
Contact
Phone
City
State
Zip
Previous Employer
Company
How Long?
How Long?
Contact
Phone
City
State
Zip
Financial History
Any Repossessions?
- 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#
Second Reference
Name
City
State
Contact
Phone
Account#
Consent*
I agree to the below statement.
For the purposes of procuring and maintaining credit, the undersigned submits the foregoing statement and information, including any supplemental sheets, as being a true and correct statement of my/our finacial condition on the date stated. The undersigned agrees to notify us immediately in writing of any unfavorable change in finacing 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
Signature*
Date
The undersigned understands that Truck Country and/or its assignees will not process a credit order until after Truck Country or such assignees have conducted a credit investigation and determined, in its or their sole discretion, to approve the extension of credit to the undersigned. By submitting this Credit Application, the undersigned hereby authorizes a full and complete investigation by Truck Country and its assignees into the undersigned’s credit history. The undersigned further authorizes Truck Country and its assignees to conduct an investigation into the credit history of the undersigned’s proprietors, partners, shareholders, members and/or principals as Truck Country and/or its assignees see fit in its or their sole discretion. The undersigned hereby grants permission to all of the above credit references and further authorizes the use of this document (or a facsimile thereof) as consent for the release to Truck Country and its assignees of credit information by credit reporting agencies, credit bureaus, and the credit, banking and trade references supplied to Truck Country and its assignees by the undersigned. Truck Country and its assignee shall be further authorized to conduct periodic credit checks and reviews of the credit history of the undersigned and its proprietors, partners, shareholders, members and/or principals in order to continue the extension of credit to the undersigned.
Phone
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Step 1 of 6

Purchaser Present Information

If a Corporation

Trucking Experience

Employment (Last 5 Years)

Bank Reference and Contact Person

PRIMARY CREDIT REFERENCES

Truck Country

Stoops

Truck Country

Stoops