Credit Application Form

PERSONAL INFORMATION
FIRST NAME   MIDDLE INITIAL LAST NAME SUFFIX DATE OF APPLICATION
SOCIAL SECURITY NUMBER
(Format: 123456789)		 CDL NO. YRS. CDL DATE OF BIRTH (mm/dd/yyyy) MARITAL STATUS NO. OF DEPENDENTS


ADDRESS       CITY   COUNTY   STATE   ZIP
PRIMARY PHONE #     SECONDARY PHONE #   EMAIL ADDRESS      
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MORTGAGE COMPANY OR LANDLORD NAME PHONE NUMBER   HOW LONG? YRS/MOS YEARS IN AREA
- /
FORMER ADDRESS (IF LESS THAN FIVE YEARS),CITY,STATE, ZIP CODE HOW LONG? YRS / MOS
/
BUSINESS NAME BUSINESS TAX I.D. NUMBER
BUSINESS ADDRESS (IF DIFFERENT FROM ABOVE) DOT# BUSINESS PHONE NUMBER
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HAVE YOU EVER TAKEN BANKRUPTCY?
 ARE YOU SUBJECT TO ANY TAX LIENS?
 HAVE YOU EVER HAD A HOME FORECLOSURE OR BEEN EVICTED?
 HAVE YOU EVER HAD ANY ITEM REPOSSESSED?
EXPLANATION (Less than 200 characters):      
LIST OF RELATIVES
FIRST AND LAST NAME   CITY/STATE   PHONE NUMBER RELATIONSHIP
/ -
FIRST AND LAST NAME   CITY/STATE   PHONE NUMBER RELATIONSHIP
/ -
SPOUSE INFORMATION
APPLICANT'S EMPLOYMENT HISTORY FOR PAST FIVE YEARS
CURRENT EMPLOYER   PHONE NUMBER   POSITION   HOW LONG? YRS/MOS
- /
IMMEDIATE PAST EMPLOYER   PHONE NUMBER   POSITION   HOW LONG? YRS/MOS
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 TRUCK OWNERSHIP AND USAGE
PREVIOUS TRUCK OWNER?    
IF FINANCED, NAME OF LENDER(S) IS THE APPLICANT THE DRIVER?
CURRENT #: PREVIOUS #:
TRUCK TO HAUL FOR (DO NOT LIST OWN COMPANY) CONTACT PHONE NUMBER  
COMPANY NAME CITY STATE
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ADDITIONAL HAUL (IF APPLICABLE) CONTACT PHONE NUMBER  
COMPANY NAME CITY STATE
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BALANCE SHEET
ASSETS (What you own)  
LIST TRUCKS & TRAILERS OWNED   LIST NAMES OF LENDERS ON TRUCKS & TRAILERS  
Item Name: $ Item Name: $
Item Name: $ Item Name: $
Item Name: $ Item Name: $
Item Name: $ Item Name: $
Item Name: $ Item Name: $
REAL ESTATE OWNED (RESIDENCE FIRST, THEN OTHERS)        
Item Name: $    
Item Name: $    
PERSONAL VEHICLES OWNED        
Item Name: $    
Item Name: $    
Item Name: $    
OTHER ASSETS (ITEMIZE)              
Item Name: $    
Item Name: $    
Item Name: $    
TOTAL ASSETS: $    
ACCOUNT INFORMATION
BANK NAME   CITY     STATE    
 
 
 


In order to induce Transport Funding, LLC to extend credit, the undersigned represents and warrants that the information contained in the above credit application as well as in any other document provided to Transport Funding, LLC (“Transport”) by or on behalf of the undersigned now or at any time in the future, is a truthful and accurate representation of the undersigned’s financial condition. The undersigned further agrees to notify Transport in writing in the event of a material change in the undersigned’s financial condition during any time period the undersigned owes any monetary obligation to Transport.

The undersigned further agrees that Transport can use this application as authorization to obtain any documents/information needed by Transport from third parties or entities in order to process the undersigned’s request for the initial extension of credit by Transport as well as during any time period in which the undersigned owes any monetary obligation to Transport.

THE UNDERSIGNED CONSENTS TO TRANSPORT AND/OR ITS EMPLOYEES AND AGENTS, RECORDING ANY INCOMING OR OUTGOING CALLS BETWEEN TRANSPORT AND THE UNDERSIGNED AND HIS/HER/ITS AGENTS AND REPRESENTAVIVES.

         
  Customer Name (Format: FirstName LastName Suffix) Spouse Name (Format: FirstName LastName)