Credit Application Form

Personal/Business Information
Name*

First NameMiddle NameLast NameSuffix
Date of Birth*

MonthDayYear
Business Name:*
Ownership %
What type of equipment are you applying for? *
Are you a First Time Buyer?

YesNo
If Owner Operator experience, how many years/months?*
CDL experience in years/months*
Social Security Number *
Mobile Number*
E-mail*
example@example.com
Residence
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you lived at the above address?*

0-1 Year1-2 Years3-4 Years5+ Years
Home Ownership/Rent.*

OwnRentLiving with parents or relative
Have you ever filed for Bankruptcy or had a repossession?*

YesNo
Employment Information
Present Employer/ Business Name:*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years/months with the Company*
Gross monthly income*
I hereby authorize, consent and instruct Wheelhouse Lease and Finance LLC to obtain and review my credit report. This report will be obtained from a credit reporting bureau chosen by Wheelhouse. I agree that the credit report will be used for the purpose of reviewing my credit for readiness for lease or purchase of equipment. A copy of this authorization shall be as valid as the original.
Data Privacy Act and Consent Form. I/We likewise give my/our consent to Dealers, Wheelhouse Lease and Finance LLC, and Banks to share and disclose the personal or sensitive personal information.*

YES
I hereby agree that the information given is true, accurate and complete as of the date of this application submission. **

YES
Should be Empty:

Personal/Business Information

Residence

Employment Information