CAPITOL CASUALTY COMPANY CREDIT APPLICATION FOR LOAN

CAPITOL CASUALTY COMPANY CREDIT APPLICATION FOR LOAN

For the Crete Carrier Corporation or Hunt Transportation Used Equipment Sales Program
This is an application for business and commercial credit, not for consumer credit.
BUSINESS INFORMATION

If a business name is (or will be) listed in the Equipment Lease and Operating Agreement with Crete Carrier Corporation or Hunt Transportation, enter the business name and check the appropriate box. If there is no business name and an individual name is (or will be) listed in the Equipment Lease and Operating Agreement, skip to Owner Information.
Business Name (if applicable):
Type of Business

DBA for Sole Proprietor Corporation Limited Liability Company Other
OWNER INFORMATION

If there is a business name, enter information for the individual who owns the business and will be driving the vehicle. If there is no business name, enter the name of the individual who will be driving the vehicle and is (or will be) listed in the Equipment Lease and Operating Agreement with Crete Carrier Corporation or Hunt Transportation.
Name of Owner: (First, MI, Last )
If currently or previously employed by Crete Carrier Corporation or Hunt Transportation, Driver Code:
Phone (Cellular preferred):
Email:
example@example.com
Date of birth:

Month Day Year
Date
SSN:
Driver's License No.:
Number of Dependents:
Ages of Dependents:
Current street address:
City:
State:
ZIP Code:
Fax No.:
Do you own or rent?

Own Rent
Monthly payment or rent:
How long at this residence?
TRACTOR YOU WISH TO FINANCE:
YEAR:
MAKE:
MODEL:
MILEAGE:
VIN:
FAIR MARKET VALUE OF TRACTOR:
Are you a participant in ATBS Program?

NO YES
If yes, how long?
EMPLOYMENT INFORMATION
Current employer:
How long at current employer?
Monthly income:
Annual income:
ASSET INFORMATION

Description of Assets Owned
Checking Account, Savings Account, and Certificates of Deposit
Name of Institution:
Current Balance:
Automobiles
Automobile Make:
Automobile Model:
Automobile Year:
Automobile Value:
Automobile Loan Balance:
Real Estate
Name of Real Estate Lender:
Real Estate Value:
Real Estate Loan Balance:
Other Assets
Other Assets (please list):
Value of Other Assets:
Loan Balance Related to Other Assets:
Are you obligated to make alimony, support, or maintenance payment?

NO YES
To whom are the payments owed? (List Name & Address):
Amount of alimony, support, or maintenance per month:
Are you a co-maker, endorser, or guarantor on any loan or contract?

NO YES
If yes, for whom are you a co-maker, endorser, or guarantor?
To whom is this contract made?
Are there any unsatisfied judgments against you?

NO YES
If yes, to whom is this judgment owed?
Amount of judgment owed
Have you been declared bankrupt in the last 10 years?

NO YES
If yes, where were you declared bankrupt?
Year of bankruptcy
SIGNATURES: I certify that everything I have stated in this application and on any attachments is correct. By signing below I authorize you to check my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes.
Applicant's Signature

Clear
Date

Month Day Year
Date
AFTER YOU HAVE COMPLETED, SIGNED AND DATED THIS APPLICATION PLEASE FAX TO 402-475-8005 OR EMAIL TO: CREDITAPP@CAPCASUALTY.COM
Should be Empty:

CAPITOL CASUALTY COMPANY CREDIT APPLICATION FOR LOAN

BUSINESS INFORMATION

OWNER INFORMATION

TRACTOR YOU WISH TO FINANCE:

EMPLOYMENT INFORMATION

ASSET INFORMATION

Checking Account, Savings Account, and Certificates of Deposit

Automobiles

Real Estate

Other Assets