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Back to Financing
Credit Application
Click Here to Download or Print the Credit Application
Applicant Information
Requesting Credit For:
Leasing & Rental
Sales
Service
Parts
Company Name:
Federal ID:
Street Address:
City:
State:
Zip:
Phone:
Fax:
PUCO #:
Applicant Name / Title:
Applicant Email:
Business Information
Type of Business:
How Long in Business:
Business Classification:
Individual
Partnership
Corporation
S Corp
C Corp
LLC
Social Security #:
Spouse's SS # (if individual):
Partner's Name:
Partner's Social Security #:
President's Name:
Vice President's Name:
Sales Tax Exempt (If yes, please upload Exemption Certificate below):
Yes
No
Tax Exemption Certificate:
Any Lawsuits or Judgements:
Yes
No
Filed Bankruptcy:
Yes
No
Tax Obligations Due:
Yes
No
How Did You Hear About Us:
Billing Instructions
A/P Contact Name:
A/P Contact Title:
A/P Contact Phone:
A/P Contact Email:
P.O. Required?:
Yes
No
P.O. Address (if you answered yes to the question above):
Billing Address (if different from above):
Billing City:
Billing State:
Billing Zip:
Insurance
Carrier:
Agent:
Phone:
Business Reference #1 - Bank
Name:
Location:
Account Number:
Contact:
Phone:
Business Reference #2 - Bank
Name:
Location:
Account Number:
Contact:
Phone:
Business Reference #1 - Trade
Name:
Location / Account Number:
Contact:
Phone:
Business Reference #2 - Trade
Name:
Location / Account Number:
Contact:
Phone:
Business Reference #3 - Trade
Name:
Location / Account Number:
Contact:
Phone:
Business Reference #4 - Trade
Name:
Location / Account Number:
Contact:
Phone:
Business Reference #5 - Trade
Name:
Location / Account Number:
Contact:
Phone:
For Equipment Financing
Annual Sales:
Annual Profit:
Equipment Now Owned or Being Purchased #1
Year:
Make / Type:
Balance $:
Payment $:
Lender:
Account Number:
Contact:
Phone:
Equipment Now Owned or Being Purchased #2
Year:
Make / Type:
Balance $:
Payment $:
Lender:
Account Number:
Contact:
Phone:
Equipment Now Owned or Being Purchased #3
Year:
Make / Type:
Balance $:
Payment $:
Lender:
Account Number:
Contact:
Phone:
Equipment Now Owned or Being Purchased #4
Year:
Make / Type:
Balance $:
Payment $:
Lender:
Account Number:
Contact:
Phone:
Property Mortgage or Lease
Property Address:
Balance $:
Monthly Payment $:
Lender / Property Owner:
Consent and Signature
You are informed that the seller or any financing agency may request an investigative consumer report to be made about you or your character, general reputation, personal characteristics and mode of living. If this report is obtained and you so desire, the nature and scope of the report will be made available to you upon written request.
I agree, the above information is and is given for the purpose of obtaining merchandise/services on credit.
Signature:
Date:
Copyright 2024, Transport Services, Inc.