Lease Program Application

Lease Program Application

This form should be used for any new applicants and for requests to add additional equipment. For assistance, contact lease@buchta.com.
Application Type

New Lease Application (I don't have my authority or business entity)New Lease Application (I already have my authority and business entity)Add equipment to existing lease
Your Name*

First NameLast Name
Owner Number*
Your Email*
example@example.com
Your Phone Number*
Birth Date*

MonthDayYear
Date
SSN or EIN*
Driver's License Number*
State*

Street Address

Street Address Line 2

CityState

Zip Code
Expiration*

MonthDayYear
Date
Class*
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Name*
Years in Operation*
MC Number*
DOT Number
Please detail your experience in trucking*
Be sure to include any certifications, relevant work history, and what types of equipment you have experience with.
Is there anything else we should know about you?*
Please include anything you think we should know to help us make our decision. If there's something on your background check or credit report that you need to explain, this is the place to do it.
Certification & Authorization

By submitting this application, I hereby certify that the information provided is true, accurate, and complete to the best of my knowledge. I understand that any false statements or omissions may result in the rejection of my application or termination of any subsequent agreements.

I further authorize Elmer Buchta Trucking LLC to conduct a background check, including but not limited to, criminal history, MVR, and credit report, as part of the evaluation process for my application to participate in the Lease Program. I also acknowledge that the results of these checks may influence the approval or denial of my application.

I understand that the information obtained from these checks will be kept confidential and used solely for the purpose of evaluating my eligibility for the program.
Signature*
Should be Empty: