Purchaser to Drive?  Yes No ... If No ... Driver's Name   
DOB License #  
 

Primary Applicant Full Name:

Spouse Full Name:

  

Date of Birth:

 Age:

Date of Birth:

   Age:

SSN:

 No. Dep:

SSN:

  

License #:
(With State + Expiration Date)

  

Business Phone:

Primary Applicant Length of Residence:

   Years & Months

Residence Phone:

 Own/Rent:   Own Rent

Present Address:

 Mortgage/Rent Paid To:  

City-State-Zip:

Former Address:

  
   

City-State-Zip:

  
 

NEAREST RELATIVES NOT AT ABOVE ADDRESS

Name   Name  
Address   Address  
City-State   City-State  
Phone   Phone  
Relation   Relation  
       

EMPLOYMENT - PAST AND PRESENT - TWO YEARS

Company Name:

Contact / Phone Number:

 Ph#:

Address:

Position:

 How Long:
   

Company Name:

Contact / Phone Number:

 Ph#:

Address:

Position:

 How Long:
   

Company Name:

Contact / Phone Number:

 Ph#:

Address:

Position:

 How Long:

How Long as an Owner-Operator:

Nature of Business:
(Materials, Between What Points, Construction, Over-The-Road, Etc.)

Monthly Income:

PURCHASER'S FINANCIAL AND CURRENT CREDIT STATEMENT

Include:
Assets - Real Estate, Savings Account, Trucks, Trailers, Autos, Loans
Liabilities - Credit Cards, Fuel Bill, Etc.

Description Bank Phone # Acct # Asset
Value		 Payment
Amount

Amount You Owe

Have you filed bankruptcy in the last 10 years? Yes No
Any Items Repossessed? Yes No

SIGN AND DATE

The information given above is true and complete. Lender 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 Lender 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 Lender or any person requested to release such information to Lender. Transport Equipment, Inc. is authorized to check bank and credit references, and to obtain any commercial and /or consumer credit reports that Transport Equipment, Inc. deems necessary to determine credit worthiness of the applicants. The undersigned – hereby authorizes creditor to obtain consumer based reports on the owners for the purpose of evaluating the credit worthiness of said applicants and/or their business.

Today's Date
Signed By:
Your E-Mail Address
Your Title:

 


Required Fields marked with *

 

 

 


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