MTM CAPITAL CREDIT APPLICATION

Contact Information*

First NameLast Name

Contact Phone *

Area CodePhone Number

Personal Address (Cannot be a PO Box)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Social Security Number *

Date Of Birth*

Date

Bank Name*

Bank Address*

CityState / Province

Postal / Zip Code

Bank Phone Number*

Area CodePhone Number

Trailer interested in Details*

Salesman*

Would you like us to pull your*

Personal Credit $50Business Credit $50 (Must have at least 1 year in business and have existing loan or CC in the business name)Both $100 (for rate comparison)

Agreement and Terms*

By submitting this credit application, you authorize us to make inquiries into the banking and business references that you provided in this form.By signing this document you are authorizing MTM Capital, or its designee(s) or assignee(s) to obtain a credit report from any business or consumer reporting agencies or other sources that provide credit reports, account history information, credit and employment history or similar information. This may result in a hard inquiry.All information in this application and all attachments are correct to the best of my knowledge. I authorize MTM Capital LLC and/or its lenders, designee(s) or assignee(s) to verify employment and all financial and other information submitted with this application, including obtaining a consumer credit report, to act on this application. I agree that MTM Capital LLC and/or its lenders, designee(s) or assignee(s) may freely communicate credit, financial, transactional and other information about me or any owner in connection with the administration of any loan or lease, including releasing credit bureau reports to lenders working with MTM Capital LLC who may provide credit relating to this application.

FAIR CREDIT REPORTING ACT: If your application for personal or business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, contact MTM Capital LLC, 2000 Kentville Rd, Kewanee, IL 61443, 708.467.1278 within 60 days from the date of decision notification. A written statement of reasons for denial will be sent within 30 days of receiving request.

The Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capacity to enter into a binding contract); because all or part of the applicant’s income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. A number of federal agencies share enforcement responsibilities of this law. Determining which agency to contact depends on the type of creditor you dealt with.Consult the creditor to whom this application is addressed for information on its regulator, or contact The Federal Trade Commission, Consumer Response Center, Washington, D.C. 20580, 877.382.4357.

Digital Signature Name*

First NameLast Name

Digital Signature Date*

MonthDayYear

Signature*

MTM Capital Credit Application

Company Information

Existing Fleet

Haul/Work or Equipment Finance Reference

Personal Information

Bank Reference

Interested In

Agreement