Credit Application

Individual Purchaser / Lessee Statement

Location Applying To: *

Choose only one the following

First Time Buyer

Ownership Experience

Number of trucks you currently own

Number of trucks you currently operate

Name *

Address

How long at this address

Rent / Own / Other

Monthly Payment

Home Phone Number

Work / Cell Phone Number

Email Address

Social Security Number *

Date of Birth *

Previous Address (if less than 2 years)

CO-BUYER INFORMATION

Co-Buyer Name

Co-Buyer Social Security Number

Co-Buyer Birth date

Co-Buyer Email Address

Co-Buyer Address

Co-Buyer Home Phone

Co-Buyer Work / Cell Phone

Co-Buyer Employer

Co-Buyer Time on Job

Co-Buyer Income

CORPORATION/LEGAL ENTITY INFORMATION (If Applicable)

Exact Legal Name of Corporation/Legal Entity

Inc. / LLC / Other

Federal ID #

Year of Organization

Your Title

Percent Owned

Principal Officer

CURRENT EMPLOYMENT INFORMATION

Total Yrs Driving Experience *

Years as Owner Operator *

Employer Name

Employer City

Employer State

Contact Name

Phone Number

Years Here

Company Driver / Owner Operator / Other

Future Employment

Employer Name

City

State

Contact

Phone Number

Monthly Miles

Monthly Revenue

Paid / mi % of Gross

Products Hauled

Commercial DL #

State

Previous Employers

Employer 1

Employer 2

Employer 3

TRUCKS / TRAILERS OWNED

Item 1

Item 2

Item 3

Item 4

Purchase

Stock Number

Desired Payment Amount

Salesperson

Trade

Truck Description

Balance Owed To

Photo of your CDL License

PLEASE READ AND ACKNOWLEDGE BEFORE SUBMITTING

Sign here to indicate the information you agree to the following terms:

(1) You confirm that you or your company has requested credit from OTC Financial Services.

(2) You authorize OTC Financial Services or other Financing Source (defined below) to verify and/or obtain information from credit reporting agencies and other third parties, including information about you (as applicant, principal of your company, or guarantor, as applicable) and about your company as applicant (if applicable), that OTC Financial Services or other Financing Source deems appropriate in considering the request for credit, and subsequently for any future purposes in connection with existing or contemplated extensions of credit to the borrower, to you, or to any entity in which you are the owner, director, manager, or officer.

(3) You authorize and instruct any credit reporting agency or other third party to provide such information to OTC Financial Services or other Financing Source.

(4) You authorize OTC Financial Services to refer the request for credit and any such information to any parent or affiliate of OTC Financial Services, or to any unaffiliated financial institution or other potential lender or lessor (OTC Financial Services and each such other party, a “Financing Source”).

(5) You certify that you have read and agree to the terms of his Authorization and the accompanying credit application and that the information in both documents is complete and true.

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