COMMERCIAL FINANCE SOLUTIONS FOR
GROWING BUSINESSES
RICHMONDTRUCKS.COM CREDIT APPLICATION
Trucking Company
888.622.0497 - 888.622.0498
(fax)
Date: _________________
Company
Name/DBA_____________________________________________________________Fed ID#______________________
Contact______________________________________ ( ) Corp. ( ) Partnership ( ) Sole Proprietor ( ) LLC ( ) PC or PA
Street__________________________City________________________State_______Zip__________Yrs
in Business___________
Phone______________________Fax____________________Cell_________________
Years in Industry:________
Previous
Employer:______________________________Time:______ Where will Equipment be
based?________________________
No#.Power Units Operated: ______ No#.
Trailers Operated: ______ Type Unit: Van ____ Reefer ____ Flat Bed ____ Lowboy
_____
Haul Radius: Local ___ Regional ___ National___ Type Product Hauled ________________________________________________
Own
ICC
Authority? Yes _____ No____ #_________________________________
PRINCIPAL(S)
OR GUARANTOR(S)
HAS
PRINCIPAL OR COMPANY FILED BANKRUPTCY IN THE LAST 10 YEARS? ( ) YES ( ) NO
_______________________________________________________________________________
___________________________
(Name)
(Title/%Ownership)
(Home Address & Phone)
(Date of Birth) (Social Security
#)
_______________________________________________________________________________
____________________________
(Name)
(Title/%Ownership)
(Home Address & Phone)
(Date of Birth) (Social Security
#)
BANK
REFERENCES (NEED AT LEAST 2 YEAR HISTORY, PLEASE)
________________________________________________________________________________
(Name)
(Phone) (Account Number)
(Date Opened)
(Contact Name)
___________________________________________________________________________________________________________
(Name)
(Phone) (Account Number)
(Date Opened)
(Contact Name)
Loan
History Past or Present
___________________________________________________________________________________
(Bank)
(Phone)
(Loan Number)
(Amount)
CONTRACT
HAUL INFO:
Company
Name:__________________________ Contact:__________________
Phone:____________________Written__ Verbal___How Long_____
Company
Name:__________________________ Contact:__________________
Phone:____________________Written__ Verbal___How Long_____
CREDIT RELEASE: I
hereby authorize the release of all credit information to and consent to the
obtaining and use of my consumer credit report by any agency involved in
securing funds for the above company, their designee, assigns/potential assigns
at anytime, for obtaining credit, and applicable account maintenance. I understand that this information may
be transmitted via Internet and/or fax machine. I consent to the photocopying of my
drivers license for verification purposes in connection with a commercial lease
transaction .I also consent to receiving unsolicited faxes and emails wherein
the involved agency will advocate its services. The Patriot Act now requires
Date of Birth
X
Date:___________ X
Date:_____________
Applicant’s
Signature
Applicant’s
Signature
Description
of Equipment or Vehicle
|
No# Units: ____ (New___ Used
___) Year:________ Mfg Make:
__________________________Model/Type: ____________________
____ Other: |
EQUIPMENT
COST
TERM______ MONTHS
PURCHASE OPTION_____________ #ADV PYMTS _______
VENDOR
PHONE
_______________________ FAX
ADDRESS
CONTACT