Online Credit Application

Thank you for using the Online Credit Application.  Please fill in all the information that you can.  Required fields are denoted by *.  Click the Submit Application button after you have entered all of your information.

 

Branch    *
 

Personal Information

Name  *  
Social Security Number  *    Date of Birth   * (mm/dd/yyyy)
Spouse Name     Spouse SSN 
Address (No P.O. Box)  *
 *   *   *
County  *  
Phone  *  
Own/Rent  *  
How Long at Address  *    *  
Former Address
(If at present address
less than 2 years)		  
CDL #  
Nearest Relative Not
Living with You		  
Address  
Phone  
 

Business Information

Business Name
Address
Phone
Tax ID#
Form of Business
Incorporation Date  (mm/dd/yyyy)
Incorporation State
Principals Percent Owned SSN Title
 

Employment for the Past 5 Years (Start with Most Recent)

Employer Years of Service Phone Contact
 *  *  *  *
How Long in Business
How Long as an Owner Operator
Lease with Current Employer
If No, New Lease
 

Truck/Trailer Credit - Past and Present

Number of Trucks Owned
Number of Trailers Owned
Have You Had Any
of the Following		 Bankruptcy
Repossession
Tax Liens
Explanation
Truck Credit Phone Contact Account # Date Opened Collateral
 
Bank Name Phone Contact Account # Balance
 

By clicking the Submit Application button below, you agree that the information given above is true and complete. Truck Enterprises, Inc. or any of its' subsidiaries 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 Truck Enterprises, Inc. or any of its' subsidiaries, credit experience and account information on Applicant.  This shall be continuing authorization for all present and future disclosures of account information and credit experience on Applicant made by Truck Enterprises, Inc., any of its' subsidiaries, or any person requested to release such information to Truck Enterprises, Inc. or any of its' subsidiaries.