Atkinson Truck Sales Credit Application
Salesmen:
Applicant Information
Full Name:
*
First Name
Last Name
Date of Birth:
*
-
Month
-
Day
Year
Date
SSN:
*
Address:
*
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number:
*
Format: (000) 000-0000.
E-mail:
example@example.com
Please Select One:
*
Own
Rent
Monthly Payment or Rent:
*
How Long?
*
# of Fleet Maintained Trucks:
Previous Address:
Street Address
Street Address Line 2
City
State
Zip Code
Please Select One:
Owned
Rented
Monthly Payment or Rent:
How Long?
Employment Information
Current Employer:
*
How Long:
*
Employer Address:
*
Street Address
Street Address Line 2
City
State
Zip Code
Phone:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Fax:
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
example@example.com
Position
*
Please Select One
*
Hourly
Salary
Annual Income:
*
Previous Employer:
How Long:
Previous Employer Address:
Street Address
Street Address Line 2
City
State
Zip Code
Phone:
Please enter a valid phone number.
Format: (000) 000-0000.
Fax:
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
example@example.com
Position:
Please Select One:
Hourly
Salary
Annual Income:
Name of a Relative NOT Residing With You:
First Name
Last Name
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship:
Relative's Address:
Street Address
Street Address Line 2
City
State
Zip Code
Co-Applicant Information
If For A Joint Account
Full Name:
First Name
Last Name
Date of Birth:
-
Month
-
Day
Year
Date
SSN:
Address:
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
Format: (000) 000-0000.
E-mail:
example@example.com
Please Select One:
Own
Rent
Monthly Payment or Rent:
How Long?
Trade References
Name:
*
Contact:
*
Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
*
example@example.com
Fax:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address:
*
Street Address
Street Address Line 2
City
Province
Zip Code
Name:
Contact:
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
example@example.com
Fax:
Please enter a valid phone number.
Format: (000) 000-0000.
Address:
Street Address
Street Address Line 2
City
Province
Zip Code
Loan or Lease References
Reference:
Contact:
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State
Zip Code
Reference:
Contact:
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State
Zip Code
Authorization
*
"By checking this box, we hereby authorize the release of all credit information, including loans, leases, checking, savings, trade references, and personal credit history, pertaining to the company, its principals, and the people listed below, to Atkinson Truck Sales (and its designee or assignee). Such Authorization shall extend to subsequent updates for credit or collection purposes. Each undersigned individual(s), who is either a principal of the credit applicant listed below or a personal guarantor of its obligations, provides written instruction to Atkinson Truck Sales or its designee (and any assignee or potential assignee thereof) authorizing review of his or her personal credit profile from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering the application of the credit applicant and subsequently for the purpose of update, renewal or extension of such credit and for reviewing or collecting the resulting account. All of the people signing below are 18 years or older. A photostatic or facsimile copy of this authorization shall be as valid as the original."
Digital Signature Of Applicant:
*
Date
*
-
Month
-
Day
Year
Date
Digital Signature Of Co-Applicant (If for Joing Account):
Date
-
Month
-
Day
Year
Date
Subject to Approval
Please verify that you are human
*
Continue
Continue
Should be Empty: