Hagerman Truck Sales 541-942-6455
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Hagerman

Credit Application

APPLICATION TYPE


Partnership Proprietorship Nonprofit Org. Corporation

Corporation Tax ID Number, if applicable  

PERSONAL INFORMATION


Primary Applicant  
Full Name  
License No.  
(With State + Expiration Date)
Date Of Birth   Age
S.S. Number      No. Dependents 
Business Phone  
Residence Phone  
Spouse  
Full Name  
Date Of Birth   Age
S.S. Number  
Present Address  
Address Line 1  
Address Line 2  
City-State-ZIP  
How long?   Years & Months
Own/Rent   Own Rent
Mortgage/Rent Paid To  
Former Address  
Address Line 1  
Address Line 2  
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

Name Address
City State Phone Relation

Name Address
City State Phone Relation

Name Address
City State Phone Relation

EMPLOYMENT - PAST & PRESENT - FIVE YEARS


Company Name  
Contact Name      Phone 
Address  
Position     How long? 
Company Name  
Contact Name      Phone 
Address  
Position    How long?
Company Name  
Contact Name      Phone
Address  
Position    How long?
How long as an owner-operator?  
Nature Of Business  
(Materials, Between What Points,
Construction,Over-The-Road, Etc.)
Gross Monthly Income  

TRADE-IN DESCRIPTION


Truck  
Year-Make-Model  
Engine  
Transmission  
Rears  
Sleeper  
Serial Number  
Condition   Good Fair Poor
Title State  
Months In Loan  
Payment Amount  
Amount Still Owed  
Other Info  
Trailer  
Year-Make-Model  
Length-Width-Height  
Serial Number  
Condition   Good Fair Poor
Title State  
Months In Loan  
Payment Amount  
Amount Still Owed  
Other Info  

PURCHASER'S FINANCIAL & CURRENT CREDIT STATEMENT


Examples: How To Fill Out This Section
Include:
  • Assets - Real Estate, Savings Account, Trucks, Trailers, Autos, Loans
  • Liabilities - Credit Cards, Fuel Bill, Etc.
Description Bank Phone Acct. No.

Asset Value Payment Amount Amount You Owe

Description Bank Phone Acct. No.

Asset Value Payment Amount Amount You Owe

Description Bank Phone Acct. No.

Asset Value Payment Amount Amount You Owe

Description Bank Phone Acct. No.

Asset Value Payment Amount Amount You Owe

Description Bank Phone Acct. No.

Asset Value Payment Amount Amount You Owe

Have you filed bankruptcy in the last 10 years? Yes No
Any items repossessed? Yes No

SIGN & 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 Email Address
 Your Title

Disclaimer: "Email is not considered to be a completely secure medium for the transmission of sensitive information. Those who email credit application information do so at their own risk."
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