Credit Application

APPLICATION TYPE

Partnership Proprietorship Nonprofit Org. Corporation

Corporation Tax ID Number, if applicable  

PERSONAL INFORMATION
Primary Applicant  
Full Name  
License No.  
(With State + Expiration Date)
Date Of Birth   Age
S.S. Number     No. Dependents
Business Phone  
Cell Phone  
Residence Phone  
Spouse  
Full Name  
Date Of Birth   Age
S.S. Number  
Present Address  
Address  
City-State-ZIP  
How long?   Years & Months
Own/Rent   Own Rent
Mortgage/Rent Paid To  
Former Address  
Address  
City-State-ZIP  

CORPORATION INFORMATION

Corporation Name  
Incorporated in what state?  
Date Of Incorporation  
Date In Business  
Principal   Age
Principal Title   % Owned
Principal   Age
Principal Title   % Owned

NEAREST RELATIVES NOT AT ABOVE ADDRESS


Name Address City-State Phone Relation

EMPLOYMENT - PAST & PRESENT - FIVE YEARS


Company Name  
Contact Name     Phone 
Address  
Position    How long? 
Company Name  
Contact Name     Phone 
Address  
Position    How long?
Company Name  
Contact Name     Phone
Address  
Position    How long?
How long as an owner-operator?  
Nature Of Business  
Gross Monthly Income  

PURCHASER'S FINANCIAL & CURRENT CREDIT STATEMENT

Assets: Real Estate, Savings Account, Trucks, Trailers, Autos.
Liabilities: Credit Cards, Auto, Equip. Mortgage Loans, Etc.
Description Bank Phone Acct. No. Asset
Value		 Payment
Amount		 Amount
You Owe
Have you filed bankruptcy in the last 10 years? Yes No
Any items repossessed? Yes No

TRUCK INTERESTED IN PURCHASING
Year-Make-Model  
Purchase Amount  
Down Payment Amount  
Financing Amount  
Descprition/Specs Truck Interested In  

TRADE-IN TRUCK DESCRIPTION
Year-Make-Model  
Condition   Good Fair Poor
Amount Still Owed  
Brief Descprition/Specs  

PLEASE PRINT YOUR SALESMAN
This will help speed up things!!
Should you not have one, put [no saleman], we will asign you one!

Jason, Gary, Glenn, Grey, Randy

Salesman  

PLEASE SIGN, SOCIAL SECURITY & DATE

"By submitting the above information, individual(s) who is either a principal of the credit applicant or a personal guarantor of its obligations, provides submitted instruction to Atkinson Truck Sales, or its designees, assignee and/or successor(s)-in-interest authorizing review of his/her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or collecting the resulting account. A copy of this application shall be valid as the original."
Today's Date
 Signed By


 Social Security #

Your E-mail Address

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