Credit Application for Trailer Purchase

Basic Information

Legal Name:
Address:	(include your city, state, zip)
Billing Address: (if different)	(include your city, state, zip)
Contact:		ICC #:
Phone:		Federal Tax ID #:
Fax:		Yrs in Business:
Organization Type:	Corporation Partnership Proprietorship

Owner's Name	Title	Social Security #	% of Ownership

Fleet Statistics

	Owned	Leased	Owner/Operators	Total
No. of Trucks:
No. of Trailers:
Intended use of new equipment:		Growth Replacement Both If Both, what percentage will be for growth? %

Bank and Financing Information

Bank Name:		Customer Since:
Contact:		Credit Line:
Phone #:		Current Balance:
Fax #:

Equipment Financing		Equipment Financing
Name:		Name:
Phone #:		Phone #:
Fax #:		Fax #

Hauling References

Company Name	Contact	Phone	Length of Relationship

To: Fleetco, Inc. and their Assigns.

I certify that the information stated in this profile is true and correct to the best of my knowledge and is provided for the purpose of obtaining credit. I understand that you will retain this information whether or not I am approved for credit. You are hereby authorized to check my credit, obtain insurance information and answer questions about your credit experience with me. I authorize you to contact my creditors and authorize any creditor contacted to release to you such credit information as you may request.