Atkinson Truck Sales, Inc.

Please fax the completed application to 434-432-9774

Credit Application

APPLICANT:

Legal company name:

Proprietorship, partnership, corporation, other:                                                                        FEI# (if any)

Address:

City:                                                        County:                                               State:                                 Zip:

Phone:                                                              Fax:                                                        Cell Phone:

Email:                                                                            Website:

Equipment will be located at-Same as above:                                                             Other:

Type Of Business:

Time in business under current ownership:                                                                       At this location:

PRINCIPALS:

Name:                                                                                                         Social Security#:

Title:                                                             % of ownership:                                                  Home Phone:

Address & Zip Code:

Name:                                                                                                         Social Security#:

Title:                                                             % of ownership:                                                  Home Phone:

Address & Zip Code:

EQUIPMENT TO BE FINANCED:

 

Dealer: Atkinson Truck sales, Inc. New/Used/Age:                                                         Equipment cost: $

BANKING REFERENCE:                                                                                    Contact:

City & State:                                                                                                              Phone:

Type of Account:                                                                                                Account Number:

LOAN OR LEASE REFERENCE:                                                                       Contact:

Account Number:                                                           City & State:                                          Phone:

LOAN OR LEASE REFERENCE:                                                                       Contact:

Account Number:                                                           City & State:                                          Phone:

TRADE REFERENCE:                                                                                        Contact:

Account Number:                                                          City & State:                                           Phone:

TRADE REFERENCE:                                                                                        Contact:

Account Number:                                                          City & State:                                           Phone:

We hereby authorize the release of all credit informationin, including loans, leases, checking, savings, trade references, and personal credit history, pertaining to the company, its principals, and the people listed below, to Atkinson Truck Sales (and its designee or assignee). Such Authorizatuin shall extend to subsequent updates for credit or collection purposes. All of the people signing below are 18 years or older. A photostatic or facsimile copy of this authorization shall be as valid as the original."

X:                                                                Date:                          X:                                                                  Date:

Federal reserve board regulatioins give applicants the right to request a written explanation of any declined application.