AZ Truck & Equipment Credit Application

Application Type*

IndividualBusiness
Transaction Type*

RetailLeaseBalloon
Dealer Number
APPLICANT INFORMATION
Last Name (or trade name of business)*
First name*
Middle Initial*
Suffix (Jr.)*
Date of Birth*

MonthDayYear
Date
Social Security #*
Home (or business) Phone Number*
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
Type of Enterprise*

CorporationLLCPartnershipProprietorship
Type of Business
Years in Business
Months in Business
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Time at Present Address
Years*
Months*
Residence Type*

Owns OutrightBuyingRenting/LeasingFamilyOther
Monthly Rent/ Mortgage Payment*
Alimony, child support, or separate maintenance need not be revealed if you do not with to have it considered as a basis for repaying this obligation.
Present Job Title*
Present Employer*
Employer Phone Number*
Please enter a valid phone number.
Years at Present Job
Years*
Months*
Gross Income*
Income Received*

MonthlyYearly
CO-APPLICANT INFORMATION
Name

First NameLast Name
Middle Initial
Suffix (Jr.)
Date of Birth

MonthDayYear
Date
Social Security #
Home (or Business) Phone Number
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Type of Enterprise

CorporationLLCPartnershipProprietorship
Type of Business
Years in Business
Months
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Time at present address in years
Months
Residence Type

Owns OutrightBuyingRenting/LeasingFamilyOther
Monthly Rent/Mortgage Payment
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Present Job Title
Present Employer
Employer phone number
Please enter a valid phone number.
Time at present job in years
Months
Gross Income
Income Received

MonthlyYearly
I Certify that the information stated in this application is true and correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved. You and/or your assigns are authorized to check my credit and employment history, obtain insurance information and to answer questions about your credit experience with me. I authorize your to contact my creditors and authorize any creditor so contacted to release to you such credit information as you my request
Signatures

We intend to apply for joint credit
Applicant Initials only*

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Co-applicant Initials only

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Applicants Signature*

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Co-Applicants Signature

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Date

MonthDayYear
Date
Should be Empty:

APPLICANT INFORMATION

Time at Present Address

Alimony, child support, or separate maintenance need not be revealed if you do not with to have it considered as a basis for repaying this obligation.

Years at Present Job

CO-APPLICANT INFORMATION

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Signatures