Jasper, Inc. Credit Application

Business Information

Owners of Business or Non-Business Loan

*REQUIRED - DO NOT LEAVE BLANK*

Truck / Trailer Information

Trade References: Open Accounts - Parts, Service, Supplies, etc.

Agreement

THE ABOVE IS HEREBY AGREED TO AND ACCURATE AS EVIDENCED BY THE SIGNATURES BELOW. I CERTIFY THAT THE INFORMATION GIVEN IS TRUE, CORRECT AND COMPLETE AND IS GIVEN FOR THE PURPOSE OF OBTAINING CREDIT. I AUTHORIZE YOU TO VERIFY INFORMATION ON OUR COMPANY, INCLUDING REQUESTS FROM ANY COMMERCIAL OR CONSUMER CREDIT REPORTING AGENCY.

The federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age; (provided Customer has the capacity to enter into a binding contract); because all or part of Customer's income derives from any public assistance program; or because Customer has in good faith exercised any right under the Consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is Federal Trade Commission; Equal Credit Opportunity, Washington, D.C. 20580. If your application for business credit is denied, you have the right to a written statement of the specific reasons for denial. To obtain the statement, please mail your written request to: Jasper Truck Sales, Attn: Credit Dept 4335 E. Washington Blvd, Fort Wayne, IN 46803 within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request.

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