Finance Credit Application

Truck Credit Application for truck financing ONLY. For Parts, Service, Lease, and Rental

Application Type(Required)

Individual Credit Application

Business Credit Application

Dealership Location(Required)

Sales Rep*(Required)

Business / Customer, Exact Legal Name *(Required)

Full Legal Name W/ Middle Initial(Required)

Tradestyle / Dba If Different

Business Address (No Po Boxes)(Required)

Street Address City State ZIP Code

Home Address (No Po Boxes)(Required)

Street Address City State ZIP Code

Cell Phone Number(Required)

Email Address(Required)

Business Phone Number(Required)

Primary Business Vocation / Nature Of Business(Required)

SSN(Required)

DOB(Required)

Primary Business Vocation(Required)

FEDERAL TAX-ID # FEIN(Required)

State Of Formation(Required)

Date Established(Required)

# Of Medium-Duty Trucks(Required)

# Of Heavy-Duty Trucks(Required)

Annual Revenue Over $1 Million(Required)

Yes

Legal Entity(Required)

CORPORATION

INDIVIDUAL/SOLE PROPRIETOR

S-CORP

PARTNERSHIP

LLC

NON-PROFIT

PARTNERSHIP

MUNICIPAL

LLP

# Of Medium-Duty Trucks(Required)

# Of Heavy-Duty Trucks(Required)

Annual Revenue Over $1 Million(Required)

Yes

OWNER / OPERATORS PLEASE ANSWER:

# Yrs As Owner / Operator

# Yrs Of Driving Experience

Have CDL?

Which State

GUARANTOR

Full Name W/ Middle Initial

Title / Position With Applicant

Date Of Birth

Street Address (No Po Boxes)

Street Address City State ZIP Code

SSN

Cell Phone Number

Email Address(Required)

Have CDL?

OWNER / OPERATORS ONLY PLEASE ANSWER:

# Yrs As Owner Operator

# Yrs Of Driving Experience

CO-GUARANTOR / CO-SIGNOR (OPTIONAL)

Full Name W/ Middle Initial

Tradestyle / DBA If Different

Street Address (No Po Boxes)

Street Address City State ZIP Code

SSN

Cell Phone Number

Email Address

Date Of Birth

Have Cdl?

Which State

HAUL/REVENUE SOURCE

Business Name(Required)

Material Hauled(Required)

Start Date

Contact Name

Contact Phone #

Business Name

Material Hauled

Start Date

Contact Name

Contact Phone #

CO-GUARANTOR OR CORPORATE GUARANTOR (OPTIONAL)

Full Name W/ Middle Initial - Or Exact Legal Name If Business

Title / Position With Applicant

Date Of Birth

Address

Street Address City State ZIP Code

SSN Or Federal Tax-Id # If Business

Cell Phone Number

Email Address

High Credit $

Account #

Contact Name

Contact Phone #

HAUL/REVENUE SOURCES

Business Name *(Required)

Material Hauled(Required)

Start Date

Contact Name

Contact Phone #

Business Name

Material Hauled

Start Date

Contact Name

Contact Phone #

EQUIPMENT FINANCE HISTORY

Lender Name

High Credit $

Account #

Contact Name

Contact Phone #

Lender Name

High Creidt $

Account #

Contact Name

Contact Phone #

NOTES / COMMENTS

Down Payment Amount

Tax Exempt

MC/LC#

By signing below, I hereby certify that the information provided in this credit application is true, accurate, and complete to the best of my knowledge. I understand that this application will be used by EAST TEXAS MACK ("the Company") to assess my creditworthiness. I authorize the Company to use the information provided in this credit application to evaluate my credit history and financial capacity. This evaluation may include sharing this application with, and obtaining information from, one or more credit bureaus, financial institutions, or other parties ("Creditors") for the purpose of assessing my creditworthiness. I acknowledge and consent that the Company may share the information provided in this credit application with Creditors to facilitate the credit assessment process. Furthermore, I authorize Creditors to obtain and exchange any relevant information about my credit history and financial standing with the Company. I understand that false or misleading information provided in this credit application may result in the rejection of my application or termination of any subsequent agreement. I agree to promptly inform the Company in writing of any material changes to the information provided in this application. By signing this declaration, I confirm that I have read and understood the terms and conditions of this credit application and the authorization granted herein.

Signature(Required)

Name And Title(Required)

Date(Required)

EQUIPMENT FINANCE HISTORY

Lender Name

High Credit $

Account #

Contact Name

Contact Phone #

Lender Name

High Credit $

Account #

Contact Name

Contact Phone #

The following authorization(s) shall apply to this application and subsequently for the purposes of update, renewal, or extension of such credit and for reviewing or collecting the resulting account. A photo, scan, fax, or electronic submission of this authorization shall be valid as the original. By signing below, applicant(s) hereby authorize the release of credit, banking, and insurance information to [COMPANY NAME], and/or its designee(s) (and any affiliates, assignees, or potential assignees thereof, collectively, "[COMPANY NAME]") from any source including credit bureau reporting agencies, applicants bank, and/or any other entity which applicant has a current or former business relationship. I hereby represent that all of the information contained in this credit application is true, correct, and complete. Applicant authorizes [COMPANY NAME] to execute and file any UCC financing statements in its name upon approval of the loan and/or lease. Individuals signing below further represent themselves to be principals or authorized signers of applicant or personal guarantor of its obligations, and provide written authorization to review of his/her personal credit profile from a national credit bureau. A consumer report may be requested in connection with this application and, upon request, applicant will be informed whether or not a consumer report was requested, and if such report was requested, provided with the name and address of the consumer reporting agency that furnished the report. This signed application further authorizes [COMPANY NAME] to contact and execute title or insurance transactions, including release of information and authorization to make changes, if required in connection with executing a loan or lease contract related to an equipment purchase.

Signature(Required)

Name(Required)

Title(Required)

Date(Required)

GUARANTOR #2 SIGN HERE, IF APPLICABLE

Signature

Name

Title

Date

ECOA NOTICE: The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, maritial status, age (provided the applicant has the capacity to enter into a binding contract), because all or part of the applicant’s income derives from any public assistance, or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law is the Federal Trade Commission, Equal Credit Opportunity, Washington DC 20580. If your application for business credit is denied or conditionally approved, you have the right to a written statement of the specific reasons for the denial or the conditional approval. To obtain the statement, please contact Company Name within 60 days from the date you are notified of such denial or condition. We will send you a written statement of reasons for the denial within 30 days of receiving your request.

OWNER / OPERATORS PLEASE ANSWER:

GUARANTOR

OWNER / OPERATORS ONLY PLEASE ANSWER:

CO-GUARANTOR / CO-SIGNOR (OPTIONAL)

HAUL/REVENUE SOURCE

CO-GUARANTOR OR CORPORATE GUARANTOR (OPTIONAL)

HAUL/REVENUE SOURCES

EQUIPMENT FINANCE HISTORY

NOTES / COMMENTS

EQUIPMENT FINANCE HISTORY

GUARANTOR #2 SIGN HERE, IF APPLICABLE

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