Fillable Application for Credit

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Application for Credit

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  • 14 check-boxes
  • 135 other fields

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File type: PDF

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PO Box 5598
Boise, ID 83705
Phone (208) 344-2539
Fax (208) 908-5249
1) Last two (2) years’ Federal Tax Returns on the business, or individual, as applicable.
2) A current Personal Financial Statement (assets and liabilities). Please complete either the abbreviated form on this credit
application, or provide a stand-alone statement.
3) Last three (3) months’ bank statements from your primary business/personal checking account for verification of average
Applicant Information
Full Name:
Social Security Number:
Home Address:
Phone No.:
Fax No.:
City, State, Zip:
County:
Yrs. ___ Mos. ___
Own
Rent
Former Address(es) (5-Year Minimum):
Yes
No
Have you ever taken bankruptcy?
(if "yes" please explain below)
Are you a defendant in any legal action?
(if "yes" please explain below)
Have you ever had any item repossessed?
(if "yes" please explain below)
Explanation:
Co-Applicant Information
Full Name:
Social Security Number:
Home Address:
Phone No.:
Fax No.:
Application for Credit
Time at this address:
THE FOLLOWING ITEMS MUST ACCOMPANY THE COMPLETED APPLICATION:
City, State, Zip:
County:
Business Information
Business Name: Federal Tax ID#:
Business Address: Bus. Phone:
City, State, Zip:
Currently Haul For
:
Company :
Address:
Contact Name: Contact Phone:
If less than 1 year with Current Haul -- Previously hauled/worked for:
Company Name & Address Phone No. Position Held How Long?
How long as an Owner/Operator? _______ yrs. Years of Driving Experience: ______ yrs.
Operator License Number: __________________ State: __________ Exp. Date:
Freight Type: ____________________________ Geographic Territory:
Applicant to Drive?
Yes No
Driver's Operator License Number: State: Exp. Date:
Major Haul and/or Customer References
:
Name
Phone
1)
2)
3)
If NO, who will drive?
% of Annual RevenueAddress (City/State) Contact
IndpOp Rev. 5/3/2010IndpOp Rev. 5/3/2010
Page 2 of 2
Financial Information (as of application date)
$ $
$
Gross Trucking Income
$
$ + Other Income $
# Tractors
________
- Interest Expense $
# Trailers
________
$
- Depreciation Expense
$
$ $ - Lease Payments $
$ $ -
Other Operating Exp.
$
$
TOTAL ASSETS $ TOTAL LIABILITIES $ OPERATING PROFIT $
NET WORTH (Assets - Liabilities) $
TOTAL LIABILITIES & NET WORTH $
Current Equipment Loan/Lease References (or Previous Lenders if not currently indebted)
Company Phone No. Contact Name Equipment Type Account No(s).
Trade References (fuel, tires, etc.)
Company Phone No. Contact Name Type of Account Account No(s).
Bank Reference
Bank
Phone No.
Contact Name
Acct. Type
___ /___ /___ to ___ /___ /___
ASSETS
Account No(s).
Other Liabilities
Mo. Pmt. on Equip. Debt
$ ______________
LIABILITIES & NET WORTH INCOME & EXPENSES
Cash in Bank
Accounts Receivable
Equipment Owned/Leased
Other Equipment
Real Estate
Other Assets
Accounts Payable
Mortgage
Equipment Debt Financed
Bank
Phone No.
Contact Name
Acct. Type
Checking / Savings
Insurance Information (P.D. and Liability)
Insurance Co./Agent: Phone:
Carrier: Policy No(s). Exp. Date:
Finance Terms Requested
Total Sales Price: Equipment Description:
Cash Down:
Trade Allowance: Qty. New
Owed on Trade ( ) Year Used
Net Trade Make Replacement
Balance to Finance: Model Addition
Term (Months): Specs:
Trade In:
Year Make Model VIN/SN Payoff To:
The undersigned certifies that the above information, given for credit purposes is true and correct and authorizes Western Trailer Co. or its assignee and any
credit bureau or other investigative agency to investigate the references, statements, or other data listed or accompanying this application. The undersigned
authorizes all parties contacted to release credit and financial information requested as part of said investigation.
Applicant Signature: Date:
Co-Applicant Signature: Date:
PLEASE COMPLETE, AND PROVIDE, ALL INFORMATION TO EXPEDITE THE CREDIT DECISION.
Account No(s).
IndpOp Rev. 5/3/2010IndpOp Rev. 5/3/2010
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
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Application for Credit

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Completed 20 May 2021

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