Credit Application

Credit Application

If applying as a company, please complete the following section. If not, skip to "Employment Information" section.
Legal Name of Owners, Officers or Guarantors

(Principals with 20$ or more ownership must be listed below)
Name

First NameLast Name
DOB

MonthDayYear
Date
Email
example@example.com
YN
Social Security #
% Ownership
%
Cell #
Please enter a valid phone number.Format: (000) 000-0000.
Home #
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years with Company
Years Experience
Name

First NameLast Name
DOB

MonthDayYear
Date
Email
example@example.com
YN
Social Security #
% Ownership
%
Cell #
Please enter a valid phone number.Format: (000) 000-0000.
Home #
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years with Company
Years Experience
Name

First NameLast Name
DOB

MonthDayYear
Date
Email
example@example.com
YN
Social Security #
% Ownership
%
Cell #
Please enter a valid phone number.Format: (000) 000-0000.
Home #
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years with Company
Years Experience

Employment Information
Current Employer/Haul Source*
How Long? *
Years and Months
Company DriverOwner Operator
Contact Name*

First NameLast Name
Phone #*
Please enter a valid phone number.Format: (000) 000-0000.
Past Employer/Haul Service
(need 3 year history total)
How Long?
Years and Months
Company DriverOwner Operator
Contact Name

First NameLast Name
Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Past Employer/Haul Service
How Long?
Years and Months
Company DriverOwner Operator
Contact Name

First NameLast Name
Phone #
Please enter a valid phone number.Format: (000) 000-0000.
Future Employer/Haul Source
(if different)
Start Date

MonthDayYear
Date
Company DriverOwner Operator

Equipment References
Name of Finance Company/Cash*
Equipment (Year/Make/Model)*
Original Balance*
Current Balance*
Name of Finance Company/Cash*
Equipment (Year/Make/Model)*
Original Balance*
Current Balance*

The federal 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 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. The federal agency that administers compliance with this law concerning this creditor is the FTC Regional Office for the Western Region of the Federal Trade Commission, which is located at the following address: Federal Trade Commission, 10877 Wilshire Blvd., Suite 700, Los Angeles, California 90024 or also the Federal Trade Commission, Consumer Response Center, Washington, DC 20580. If we take adverse action you have a right to a statement of specific reasons for the adverse action if you request such statement within 60 days from CROSSROADS EQUIPMENT LEASE AND FINANCE, LLC at the following address 9385 Haven Ave., Rancho Cucamonga, CA 91730. The written statement shall be sent to you within 30 days. Adverse action may include refusal to grant credit in substantially the amount or terms requested, termination or an unfavorable change in the terms of an account and refusal to increase the amount of credit available.
The Applicant (which term includes the business entity named above and each owner, guarantor principal, partner or member) authorizes CROSSROADS EQUIPMENT LEASE AND FINANCE, LLC, its affiliates along with its successors and/or assigns (each, a “Creditor”) and any credit bureau or other investigative agency engaged by Creditor to investigate, obtain and share information from time to time from any source (included, but not limited to references listed in the Application) about Applicant’s credit standing and responsibility, including, but not limited to, obtaining credit reports and other financial information to evaluate this application and to review Applicant’s account. By signing this Application, Applicant authorizes Creditor, its affiliates, and assignees to share the Applicant’s credit and other information as permitted by law. The Applicant represents and warrants to Creditor that: (a) all of the representations and information provided in this application, and all other representations, statements, reports or information made or delivered to Creditor are true, complete and correct in every respect; and (b) Applicant is requesting that Creditor extend credit or enter into transactions with Applicant for commercial and business purposes only, and such transactions are not for personal, family or household purposes. Applicant represents that it has reviewed this document and the information.
Applicant Signature*

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Title (if applicable)
Date*

MonthDayYear
Date
Co-Applicant/Guarantor

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Title (if applicable)
Date

MonthDayYear
Date
Co-Applicant/Guarantor

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Title (if applicable)
Date

MonthDayYear
Date
By clicking continue, you agree to have this information passed through to a third party financing company. TruckTractorTrailer.com, Inc. is acting solely as a data intermediary and does not store PII except that which is needed to maintain a registered user account as provided for in our Privacy Policy and Terms and Conditions . Your data is encrypted during transmission and stored by the third party financing company under their policies and security practices.

Also, you authorize Innovative Lease Services, Inc. to perform a soft inquiry. The undersigned individual who is either a principal, a personal guarantor or a sole proprietorship of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents and authorizes Innovative Lease Services, Inc. or its designee the use of a consumer credit report on the undersigned, from time to time as may be needed. The Merchant and Owner(s)/Officer(s) identified above (individually, an “Applicant”) each represents, acknowledges and agrees that (1) all information and documents provided to Innovative Lease Services, Inc. (“ILS”) including credit card processor statements are true, accurate and complete, (2) Applicant will immediately notify ILS of any change in such information or financial condition, (3) Applicant authorizes ILS to disclose all information and documents that ILS may obtain including credit reports to other persons or entities (collectively, “Assignees”) (4) each Owner/Officer represents that he or she is authorized to sign this form on behalf of Merchant.

All financing products are made pursuant to: CA Finance Lender License #603D039.
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