Prairie Truck Sales
Credit Application

APPLICATION TYPE
Partnership Proprietorship Nonprofit Org Corporation

Corporation Tax ID Number, if applicable
Salesman You Spoke With: (Important)

PERSONAL INFORMATION
Purchaser to Drive? Yes No ... If No ...
Drivers Name
License #
DOB
Primary Applicant Full Name
License #
(With State + Expiration Date)
Date of Birth Age
SSN No. Dep
Spouse Full Name
Date of Birth Age
SSN
Business Phone
Residence Phone
Present Address
City-State-Zip
How Long? Years & Months
Own/Rent Own Rent

Mortgage/Rent Paid To
Former Address
City-State-Zip

CORPORATION INFORMATION
Corporation Name
Incorporated In What State
Date of Incorporation
Date In Business
Principal Age
Principal Title % Owned
Principal Age
Principal Title % Owned

NEAREST RELATIVES NOT AT ABOVE ADDRESS
Name Address City-State Phone Relation

EMPLOYMENT - PAST AND PRESENT - FIVE YEARS
1
Company Name
Contact / Phone Number Ph#
Address
Position How Long
2
Company Name
Contact / Phone Number Ph#
Address
Position How Long
3
Company Name
Contact / Phone Number Ph#
Address
Position How Long
How Long as an Owner-Operator?
Nature of Business
(Materials, Between What Points, Construction, Over-The-Road, Etc.)
Monthly Income

TRADE-IN DESCRIPTION
Year Make Model Body Style/Type
Engine Transmission Rears Serial Number
Sleeper Tractor Pkg. Other Info
Title State Months In Loan Payment Amount Amount Still Owed

PURCHASER'S FINANCIAL AND CURRENT CREDIT STATEMENT
Examples: How To Fill Out This Section
Description Bank Phone # Acct # Asset
Value		 Payment
Amount		 Amount You Owe
Checking Acct First Bank 800-888-8888 123456789 4200    
Savings Acct First Bank 800-888-8888 123456789 2450    
Ford Bronco Loan Fifth Bank 313-333-3333 4567890 15000 525 7200
1993 Freightliner FL120 National Bank 616-666-6666 123-4568 21500 800 12500
Home Loan City Savings Bank 555-555-1212 595955 120000 925 91700
Visa First Mutual 800-111-2222 4415 3341   100 6200
Stock N/A N/A N/A 8000    
Include:
  • Assets - Real Estate, Savings Account, Trucks, Trailers, Autos, Loans
  • Liabilities - Credit Cards, Fuel Bill, Etc.
Description Bank Phone # Acct # Asset
Value		 Payment
Amount

Amount You Owe

Have you filed bankruptcy in the last 10 years? Yes No
Any Items Repossessed? Yes No

SIGN AND DATE
The information given above is true and complete. Lender may receive from and disclose to other persons, including credit reporting agencies, information about Applicant's accounts and credit experience and Applicant authorizes any person to release to Lender credit experience and account information on Applicant. This shall be a continuing authorization for all present and future disclosures of account information and credit experience on Applicant made by Lender or any person requested to release such information to Lender.
Today's Date
 Signed By:


Your E-Mail Address
 Your Title:

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