Secure Finance Application

Applicant's Information

First Name

Middle Name

Last Name

E-mail

Date of Birth

Cell Phone Number

Social Security Number

Home Property is

Monthly Payment

Current Physical Address

Mailing Address (If applicable)

Name of Nearest Relative (Not Living With You)

Relative's Address

Relative's Phone Number

Relationship To You

Co-Buyer/Guarantor’s Information (If Applicable)

First Name

Middle Name

Last Name

Date of Birth

Social Security Number

Current Address

Business/Company Information

Contact To Be In The Business Name?

Legal Business Type

Year Incorporated

State Incorporated

Federal I.D. Number

Business Name (DBA)

How Long Has The Company Been In Business?

Business Address

Business Phone Number

Business Annual Sales

MC Authority Number

Radius of Operations

Years of CDL Driving Experience (License Must Be Provided Later)

How Many HEAVY DUTY TRUCKS Are Currently In The Fleet?

How Many TRAILERS Are Currently In The Fleet?

How Many MEDIUM DUTY TRUCKS Are Currently In The Fleet?

Purchasing Unit is a(n)

Garaged State

Will Purchaser Drive This Unit?

First Business Owner Information

Business Owner's Name

Business Owner's Percentage

Business Owner's Title

Second Business Owner Information

Business Owner's Name

Business Owner's Percentage

Business Owner's Title

Primary/Current Hauling Reference or Revenue Source

Company Name

Phone Number

Contact Name

Products Hauled for Company

How Long Were You With The Company?

#2 Hauling Reference or Revenue Source

Company Name

Phone Number

Contact Name

Products Hauled for Company

How Long Were You With The Company?

#3 Hauling Reference or Revenue Source

Company Name

Phone Number

Contact Name

Products Hauled for Company

How Long Were You With The Company?

Bank Information

Name Of Bank

Bank Address

Bank Contact's Phone Number

Prior Truck & Trailer Financing Reference #1

Truck/Trailer Description

Financed By

Financer’s Phone Number

Date Financed

Prior Truck & Trailer Financing Reference #2

Truck/Trailer Description

Financed By

Financer’s Phone Number

Date Financed

Prior Truck & Trailer Financing Reference #3

Truck/Trailer Description

Financed By

Financer’s Phone Number

Date Financed

Additional Questions

Have You Ever Declared Bankruptcy?

Are You Currently a Defendant In Any Legal Action?

Have You Ever Had an Item Repossessed?

Explain All Above Questions Answered as Yes (If Applicable)

Authorization & Disclaimer

THE UNDERSIGNED CERTIFIES THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE & CORRECT & AUTHORIZES THAT RIHM FAMILY COMPANIES MAY ASSIGN OR TRANSFER THIS CREDIT APPLICATION AND MAY ALSO COMMUNICATE THE INFORMATION CONTAINED HEREIN TO OTHERS & OBTAIN INFORMATION ABOUT THE UNDERSIGNED’S ACCOUNTS & CREDIT EXPERIENCE IN ORDER TO DECIDE WHETHER OR NOT TO EXTEND CREDIT. THE UNDERSIGNED ALSO AUTHORIZES ALL PARTIES CONTACTED TO RELEASE CREDIT & FINANCIAL INFORMATION REQUESTED BY RIHM FAMILY COMPANIES AND/OR THE LENDER. THIS APPLICATION SHALL SERVE AS A CONTINUING AUTHORIZATION FOR ALL PRESENT & FUTURE INQUIRIES & DISCLOSURES OF ACCOUNT INFORMATION & CREDIT EXPERIENCE ON THE UNDERSIGNED TO RELEASE SUCH INFORMATION.

THIS APPLICATION IS COMPLETED THROUGH A SECURE WEBSITE. ALL INFORMATION PROVIDED IN THIS FORM AND YOUR IDENTIFY ARE SECURE AND SAFE.

Digital Signature

Date

Secure Truck Finance Application