66Trailers - Credit Application

Applicant Contact Information
Applicant Name

First NameLast Name
Applicant Title
Applicant Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Applicant Email
example@example.com

Bank Reference
Bank Name
Last 4 Digits of Account #
Account Type
Branch Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please submit copies of the account summary page from the last 3 months bank statements for the account listed above. (Please redact sensitive information you do not wish to share)
Bank Statement #1
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Bank Statement #2
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Bank Statement #3
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Trade Reference

(Example: Any lending/financing institution, Repair Shop, Fuel Card Company, etc.)
Company Name
Contact
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address (Include City, State, Zip)

Street Address Line 2

City

Zip Code
Trade Reference

(Example: Any lending/financing institution, Repair Shop, Fuel Card Company, etc.)
Company Name
Contact
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address (Include City, State, Zip)

Street Address Line 2

City

Zip Code

Authorization to Obtain Credit Information

By signing below, the undersigned ("Applicant") hereby authorizes 66 Trailers, LLC and its agents to investigate and obtain credit information from business credit bureaus, banks, trade references, and other financial institutions, for the purpose of evaluating Applicant's creditworthiness in connection with leasing or other business transactions with the Company. Applicant further authorizes all banks, financial institutions, credit reporting agencies, trade references, and other persons or entities to release any and all information requested by 66 Trailers, LLC in connection with this application. A copy, fax, or electronic version of this authorization shall be considered as valid as the original. The undersigned, by execution of this credit application, agrees that they shall pay for all outstanding balances per terms asagreed between both parties.

If credit is being extended to a new or non-established business, the undersigned may be asked to complete a personal guarantee allowing 66 Trailers, LLC to assess the individual's creditworthiness via personal credit bureaus.
Name

First NameLast Name
Title
Signature
Please Submit an official form of ID (Drivers License, CDL, etc.)

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Date

MonthDayYear
Date
Time

Hour Minutes

AM/PM Option
Should be Empty:

66Trailers, LLC