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 initial 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
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(Initial here)
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Vehicle Information
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Salesman (if known)
Dealer Location
Stock Number (if known)
Type
Year
Make
Model
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Credit Type

Name As It Appears on Drivers License

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Credit Type Sales     Rentals Parts Service
Business Information
Type of Business
Business Name or Owner/OP Name
Federal ID
First Name
Last Name
Subject
Address
City
State
Zip (xxxxx)
Time at Address Years Months
Rent or Own
Office Phone (xxx-xxx-xxxx)
Fax
Mobile Phone (xxx-xxx-xxxx)
Social Security Number
Date of Birth
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Legal Actions
Have you filed bankruptcy? Yes   No  
Are you defendant in any legal action? Yes   No  
Do you have any items repossessed? Yes   No  
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
Trade references
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)
Haul Sources/Employment (2 Years History)
Work history & references (shippers and/or brokers)
Company name
Contact name
Phone number
Time with Employer
Company name
Contact name
Phone Number
Time with employer
Applicant Electronic Signature

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.
Applicant Signature:   Date:  
Title
Email Address
Confirm Email
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