Secure Finance Application

Statement of Consent

I certify that the information provided by me is correct. I also understand that you will be checking with credit reporting agencies. I authorize an investigation of my credit and employment history and the release of information about my credit experience.

Please provide your electronic signature below to indicate that you have received a copy of our Privacy Notice and agree to all of the above.

YOUR CREDIT APPLICATION IS GOING THROUGH A SECURE WEBSITE AND YOUR IDENTITY IS SAFE

Initial Here

Are you working with a salesperson? If yes,who?

Stock Number

Credit Type

Sales

Rentals

Parts

Service

Vehicle Information

What type of trailer are you looking for?

Condition

Year

Down Payment

Business Information

Name As It Appears on Driver's License

Type of Business

Business Name or Owner/OP Name

Federal ID

Years in Business

Date Established

First Name

Last Name

Driver's License

Driver's License State Issued

Driver's License Expiration Date

E-mail

Social Security Number

Date of Birth

Address

City

State

Zip

Time at Address

Do you Rent or Own your home, or other?

Office Phone

Fax

Mobile Phone

Legal Actions

Have you filed bankruptcy?

Are you defendant in any legal action?

Do you have any items repossessed?

Fleet Size

Driving experience

Years Driving

Number of tractors dispatched

Number of tractors owned

Owner/Operator experience

Years Driving

Number of trailers owned

Prior and Current Commercial Vehicle Loans

Who financed previous truck/trailer?

Prior commercial lenders or paid cash (1)

Phone number (1)

Date account opened (1) (month, year)

Prior commercial lenders or paid cash (2)

Phone number (2)

Date account opened (2) (month, year)

Haul Sources/Employment (2 Years History)

Work history & references (shippers and/or brokers)

Company Name

Contact Name

Employer Phone

Time at Employer

Company Name

Contact Name

Employer Phone

Time at Employer

Applicant Signature

Please provide your electronic signature below to indicate that you have received a copy of our Privacy Notice and agree to all of the above.

Applicant Signature

Date

Title

E-mail

Confirm E-mail