Equipment Credit Application Form

Equipment Credit Application Form
Business And Personal Credit Information
Business Name or Individual*
Year Business Started*
Business Address*

Street Address

Street Address Line 2

CityState

Zip Code
Business Entity Type
Federal Tax ID
MC Number
Equipment Address*

Street Address

Street Address Line 2

CityState

Zip Code
Primary Insurance
Business Phone Number*

Area CodePhone Number
Email*
example@example.com
US Citizen?*
Ever Filed Bankruptcy?*
Judgements/Liens?*
Total Revenue* Total Expenses* Net Income*
Fleet Size (# of units): Trucks * Trailers *
References

Finance References*

	Company Name	Contact Name	Phone	Account Number
Reference 1
Reference 2
Reference 3

Top 3 Customers (Haul sources)*

	Company Name	% of Sales	City, State	Duration of Haul
Reference 1
Reference 2
Reference 3

Ownership/Guarantor Information
Owner # 1 Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number*
Date of Birth*

MonthDayYear
Date
Ownership % and Title*
Owner Credit Score*

Assets*

	Assets (Fair Market)
Checking/Savings
Investments
Vehicles
Real Estate
Company Equity
Other
Total Assets

Liabilities*

	Liabilities (Current Balance)
Credit Cards
Line of Credit
Vehicle Loans
Mortgages
Notes Payable
Other
Total Liabilities

Net Worth (Total Assets - Total Liabilities)*
Owner # 2 Name

First NameLast Name
Phone Number

Area CodePhone Number
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Social Security Number
Date of Birth

MonthDayYear
Date
Ownership % and Title
Owner Credit Score

Assets

	Assets (Fair Market)
Checking/Savings
Investments
Vehicles
Real Estate
Company Equity
Other
Total Assets

Liabilities

	Liabilities (Current Balance)
Credit Cards
Line of Credit
Vehicle Loans
Mortgages
Notes Payable
Other
Total Liabilities

Net Worth (Total Assets - Total Liabilities)
Equipment
Please share what equipment you are looking to finance. Year, make, model, price, quanity
Type a question
Agreement
For the purposes of establishing and maintaining credit for a commercial purpose and not primarily for personal, family, or household purposes, the undersigned hereby authorizes Driver Advantage Equipment Financing, Inc., or a third-party, or consumer reporting agency acting on the Driver Advantage Equipment Financing, Inc.’s behalf to make inquiry into, to request, to obtain credit reports, and to receive any information concerning the applicant and owners’ character, general reputation, employment, and all information from creditors deemed relevant for the granting and collection of the proposed borrowing or credit account. The undersigned authorizes all persons, corporations; credit agencies; employers, law enforcement agencies; city, state, county, and federal courts; and military services to release any such information about applicant and owners’ background. I do hereby certify that the above information is true and correct to the best of my knowledge. The undersigned further certifies and agrees that the acceptance by Driver Advantage Equipment Financing, Inc. of the Credit Statement in no way obligated Driver Advantage Equipment Financing, Inc. to extend credit or to arrange credit for the undersigned. Driver Advantage Equipment Financing, Inc. may deny the undersigned creditor assistance in obtaining credit for any reason or for no reason.

By signing this application, I acknowledge all of the above.
Owner #1 Signature*
Owner #2 Signature
Should be Empty:

Equipment Credit Application Form

Business And Personal Credit Information

References

Ownership/Guarantor Information

Equipment

Agreement