CREDIT APPLICATION
INDIVIDUAL / SOLE OWNERSHIP BUSINESS APPLICANT
What equipment are you applying for?
Make & Model
Location applying at
Bakersfield, CA
Delano, CA
Santa Maria, CA
Nearest Location
Name
First Name
Middle Name
Last Name
Social Security #
Date of Birth
-
Month
-
Day
Year
Date
Driver's License #
Driver's Licence State
Driver's Licence Expires on:
-
Month
-
Day
Year
Date
Upload Photo of Driver's License
Browse Files
Cancel
of
Street Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone #
-
Area Code
Phone Number
Residence Status
Own
Rent
Years at Address
Less than 3 Years? Give Previous Address
Street Address
# of Years.
City
State / Province
Postal / Zip Code
Intended Use of Equipment
Employer Name
Position:
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gross Monthly Salary
Employer Phone Number
-
Area Code
Phone Number
# of Years
If less than 2, Provide Previous Employer Below.
Previous Employer Name
Previous Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
# of Years at this Employer
Nearest Relative NOT living with you
Name
First Name
Last Name
Relationship
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
BUSINESS APPLICANT
Business Type:
Proprietorship
Partnership
Corporation
LLC
Government
Business Name
TAX ID#
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Year Established
# of Employees
Gross Annual Income
Gross Annual Sales
Market Date
Name(s) of Owners or Principal Officers with Titles
Separate Names & Titles with / or ,
INDUSTRY
Farming
Full Time, Part-time or Hobby?
Type of Livestock/Crops
# of Acres Owned
# of Acres Rented
Construction
Sand/Gravel
Excavating
Plumbing/Sewer
Landscape/Mowing
Golf Course
If Contractor
Prime
Sub
Give name of Primary
If Sub
CO-APPLICANT / GUARANTOR TO BUSINESS
Name
First Name
Middle Name
Last Name
Social Security #
Date of Birth
-
Month
-
Day
Year
Date
Relationship to Primary Applicant
Driver's Licence #
Driver's Licence State
Driver's Licence Expires on
-
Month
-
Day
Year
Date
Upload Photo of Driver's Licence
Browse Files
Cancel
of
Street Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone #
-
Area Code
Phone Number
Residence
Own
Rent
Years at Address
Less than 3 years? GIve Previous Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
# of Years
Employer Name
Position
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Gross Monthly Salary
Employer Phone #
-
Area Code
Phone Number
# of Years
If less than 2, List Previous Below
Previous Employer Name
Previous Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
# of Years
Nearest Relative NOT living with you:
Name
First Name
Last Name
Relationship
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Other Income
Source
Monthly Amount
CREDIT REFERENCE
Creditor
Contact
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Loan #
INSURANCE COVERAGE
will be required if property/equipment is used as security.
My Insurance Agent will send a Certificate
Please finance the required Coverage
Agent Name
First Name
Last Name
FAX #
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Has any applicant had any unsatisfied judgments rendered against them or equipment repossessed in the last 7 years, or been declared bankrupt in the last 10 years?
Yes
No
NOTICE TO CALIFORNIA RESIDENTS:
If you are married you may apply for a separate account.
I hereby certify that these statements are correct to the best of my knowledge and are made for the purpose of obtaining financing. I authorize you to obtain any information including but not limited to credit reports which you may require concerning this application and I agree that this application shall remain your property, whether the financing is granted or not, I acknowledge receipt of a copy of this application sheet.You have my consent to obtain my credit report in connection with my application for credit and for any of the following purposes:Extending credit to me, reviewing my account, increasing the credit line on my account, confirming my current address and telephone number, taking collection action on the account, and other legitimate purposes associated with the account.
Applicant's Signature
Clear
Date
-
Month
-
Day
Year
Date
Co-Applicant/Guarantor's Signature:
Clear
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm