Horwith Freightliner,
Northampton PA. |
CREDIT APPLICATION |
Please print, fill out and fax to 610-261-2916 |
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|
|
| Purchaser:
______________________________________ Phone: ( )
____________________ |
| Address: ____________________________________________ |
City:___________________________
County:_________________ State:________ Zip:_______
|
| CUSTOMER INFORMATION: |
|
|
| Date of Birth:____________ |
Social Security No.:_________________ |
Years at Present Address:______ |
|
| Previous Address: |
| Street: __________________________________________________
Since:__________________ |
| City: __________________________________ State:
________________ Zip: ______________ |
| ______________________________________________________________________________ |
| Street: __________________________________________________
Since:__________________ |
City: __________________________________ State:
________________ Zip: ______________
|
|
| Home of Principal: |
 |
Own / Buying |
|
Renting |
|
Mobile Home |
|
Live with Relatives |
|
|
| SPOUSE INFORMATION: |
| Date of Birth: _____________________ Social Security No.
______________________ |
| Employer:__________________________________________ Phone:
(____)___________ |
Time on Job ( _______Years _______ Months )
Annual Income: ______________________
|
| EMPLOYMENT INFORMATION: |
| Truck (s) to be operated for:
____________________________________________________ |
| Contact: _________________________________ Phone
(____)________________________ |
| Employed: (________Years ______Months ) Type of contract:
Written Oral |
| Total Years in Trucking: _____ No. of Trucks Owned: ________
No. of Trucks Leased: ________ |
| Type of Use: __________________________________________________ |
Commercial Drivers Licence # : ______________________
Expires: _________________
|
|
| PREVIOUS EMPLOYMENT: |
| Company: ________________________________________________________ |
| Contact: ______________________________ Phone:
________________________________ |
| Employed: (________Years ______Months ) Occupation:
____________________________ |
|
| Company: ________________________________________________________ |
| Contact: ______________________________ Phone:
________________________________ |
| Employed: (________Years ______Months ) Occupation:
____________________________ |
|
| FINANCIAL INFORMATION: |
| References ( relatives or friends not living with you ): |
| Name |
City,State |
Phone |
Relationship |
|
| ______________________________________________________________________________ |
| ______________________________________________________________________________ |
| ______________________________________________________________________________ |
| Bank/Mortgage Company References: |
| Bank Name |
Contact |
Phone |
City |
State |
Complete Acct. # |
|
| ______________________________________________________________________________ |
| ______________________________________________________________________________ |
| ______________________________________________________________________________ |
______________________________________________________________________________
|
| Equipment Financing and Leasing References*: |
| Bank/Finance Co. |
Contact |
Phone |
City |
State |
Account Numbers |
|
| ___________________________________________________________________________ |
| ___________________________________________________________________________ |
| ___________________________________________________________________________ |
| ______________________________________________________________________________ |
* Include paid out creditors if this information is
available
|
| Legal Actions: |
Prior Bankruptcy: |
|
YES |
|
NO |
Judgments: |
|
YES |
|
NO |
Tax Liens: |
|
YES |
|
NO |
Lawsuits Pending: |
|
YES |
|
NO |
|
|
| SIGNATURE |
For the purposes of procuring and maintaining credit, the
undersigned submits the foregoing statement and information, including any supplemental
sheets, as being a full, true and correct statement of my/our financial condition on the
date stated. The undersigned agrees to notify Lender immediately in writing of any
material unfavorable changes in financial condition. We hereby grant permission to all
above creditors to release our account information to Lender.
Please attach year-end financial statements for the past two years and current prior
month-end financial statements. Financial statements should be balance sheet, profit and
loss statement, and statement of cash flows.
|
| Signature: ________________________________________ |
Title ( if applicable ) _______________________ Date:
__________________
|
|
HORWITH FREIGHTLINER, Northampton PA |
CREDIT APPLICATION |
Please print, fill out and fax to 610-261-2916 |