TruckLenders has developed an underwriting process for the transportation industry that evaluates specific information and factors in order to
generate a credit decision. The information on this submittal form is crucial to our process and necessary in order to provide you with a quick turnaround.
Please complete the form entirely prior to submitting for credit.
TruckLenders Representative:
Borrower Name:
Address: City: State: Zip:
Telephone #: Cell #: Fax #:
Brief Overview of Business:
Business Structure:
Type of Business: Tax ID Number:
Time in Business: yrs. Type of Products Hauled:
Name: Address: SS#:
Name: Address: SS#:
Homeowner? If “Yes,” time at current address: yrs. months
Gross Annual Revenues: $
Bank Reference: Avg. Bal: $ NSFs? If “Yes,” how many?
Trade Reference: High Credit: $ Within Terms?
Industry Info (must be completed):
Number of Tractors: Number of Trailers: Reason for Purchase:
Employment Status: Yrs. as O/O:
Employer (if not O/O):
Borrower is Driver? Truck Miles: Engine Miles:
Authorized Dealer Sale: Private Party Sale:
State upon which the dealer is located:
Requested Structure: Standard Balloon/PUT:
Tax Exempt Status: if “No,” will sales tax be financed?
Delivery Date:
Detailed Equipment Description:
Year Make/Model/Trailer Type Cost
Sales Tax (if not already included) $
Total Amount Requested $
Request Term
Transaction Summary
National Sales Office
28570 Marguerite Parkway
Mission Viejo, CA 92692
877-233-1475 Phone
949-366-3039 Fax
Corporate Office
23 Berry Hill Road
Oyster Bay, NY 11771
516-922-7447 Phone
516-922-6783 Fax
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