Midwest Peterbilt Group
Truck Equipment Credit Application
PERSONAL INFORMATION
* required fields
*Customer Name (required)
Doing Business As
*Date of Birth
*SSN
Commercial Driver's License
License #
Issuing State
Issue Date
*Present Address
*City
*State & Zip
*How Long? (Years & Months)
*Own/Rent
Mortgage/Rent Monthly Payment
Business Phone
*Residence Phone (required)
Cell Phone
If less that 2 yrs at the present address:
Former Address
City
State & Zip
*First Truck/Trailer Purchase?
*State Vehicle to be Titled In
*Type of Goods Hauled
*Applicant to Drive this Purchase?
Truck Driving Exp: (Yrs & Mths)
*First Time Owner/Operator?
Owner/Operator Exp: (Yrs & Mths)
*Have you ever filed bankruptcy?
*Any Items Repossessed?
*Are you a defendant in any legal action?
If you answered yes to any of the above 3, please explain:
Complete the following Only if this is a Joint Application with Spouse or if you are relying on your spouse's income or assets as a basis for repayment of the credit requested; or if you reside in a community property state, spouse must sign on page2.
Spouse Full Name
Date of Birth
SSN
Employment Position
How Long? (Years & Months)
Work Phone

NEAREST RELATIVE NOT LIVING WITH YOU

Name Relation Phone
 

COMPLETE ONLY IF APPLICANT IS NOT THE DRIVER OF THIS PURCHASE

Drivers Name
DOB
License #
Issue State Issue Date
Drivers Address
City
State Zip
Truck Driving Experience Yrs & Mths

COMPLETE ONLY IF PURCHASING IN A BUSINESS NAME

BUSINESS TYPE
Tax ID Number, if applicable
Business Name
Incorporated In What State
Date of Incorporation
Principal Name
Principal Title
Age       % Owned
Principal Name
Principal Title
Age    % Owned

BANK REFERENCES

Bank 1
Name
Phone
City
State
Bank 2
Name
Phone
City
State

EQUIPMENT PURCHASE

*Is This Additional Equipment?
If yes, Justify Expansion of Fleet:
#Leased #Owned #Owner
Operators
*No. Tractors/Trucks Before this Purchase
No. Trailers Before this Purchase

EQUIPMENT CREDIT INFORMATION

Lender
Phone
Balance
City
State
Zip
Contact
Date Opened
Make
Model
Year
Lender
Phone
Balance
City
State
Zip
Contact
Date Opened
Make
Model
Year

INCOME SOURCES

Who you drive for, leased on with, broker through, best customer? If you have your own authority, please enter your best customer or broker.
*Name
*Contact
*Phone
Gross Monthly Income
*Yrs     *Months
  
Truck to work for this income source? Yes No
 
Name
Contact
Phone
Gross Monthly Income
Yrs     Months
  
Truck to work for this income source?

TRUCK YOU ARE INTERESTED IN

Year
Body Style/Type
Make
Model
Price Range
Salesperson you're working with
How much would you like to put down?

SIGN AND DATE

Sioux City Truck Sales, Inc. uses various lenders to offer competitive rates and terms. Would you lik us to contact other lenders, other that PACCAR?
(Additional information may be required.)
 
For the purpose of establishing and maintaining credit, the undersigned submits the foregoing statement and information contained on this sheet, both written and printed, and including supplemental sheets, if any, as being a full, true, and correct statement of my financial condition and all above matters, on the date stated. The undersigned agrees to notify you immediately in writing of any materially unfavorable change in my financial condition of the above matters, and in the absence of such notice or of a new and full written statement, all matters herein may be considered as a continuing statement and substantially correct. The undersigned hereby authorizes Sioux City Truck Sales, Inc. and their lenders to make inquiry into, to request, and to receive any information concerning my character, general reputation, personal characteristics, mode of living, and all information from creditors which lenders deem relevant for the granting and collection of the proposed borrowing. This authorization shall be effective from the date upon which this application is signed and is extinguished automatically upon full payment of the present borrowing, if any is granted. Upon my written request, additional information as to the scope of this inquiry, if one is made, will be provided. I further represent that neither the undersigned, any principal officer of the undersigned, nor any contemplated operator of any equipment proposed to be purchased has any record or reputation of having violated any federal or state laws relating to liquor, narcotics or contraband, and no such person has been convicted of any felony. I understand that the lenders, and/or Seller of motor vehicle, parts or services to whom this application is presented, will be relying on the accuracy of the matters set forth herein as a basis for extending any credit which I may receive.
 this is an electronic signature and in result will be considered a signature to authorize the above.
*Signed By:
Your Title:
Spouse Signature:
Today's Date
12/14/18
*Your E-Mail Address
Attach copy/picture of Drivers License