Credit Application Form

14652 Valley Blvd Fontana, CA 92235

909-333-5124 www.fontanatruckoutlet.com
Credit Application Form
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Date of Birth

MonthDayYear
Date
Social Security Number
Company Information
Company Name
(INC, LLC or DBA)
Type of Business
Tax I.D. Number
In Business Since :

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number of Trucks
Number of Trailers
Terms & Conditions

I authorize Fontana Truck Center to obtain my credit report and verify the information provided for financing purposes. I agree to the Terms & Conditions and consent to being contacted regarding my application.
Signature

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