Location


Credit Application

Applicant Information 
NAME - First: Middle: Last: Jr. Sr.
Social Security #: Fed Tax ID#: DBA LLC INC.
Business Name: % Ownership: DOB:
Current Mailing Address
Street Address:
City: State: Zip:
County:
Physical Address (if different from mailing address)
Street Address:
City: State: Zip:
County:
Additional Information
Business Phone: Cell Phone: Fax: Email:
Own Home? Yes No     If Yes, how many years?              Ever Files Bankruptcy? Yes No             Ever Had Repossession? Yes No    
Are You A Defendant In A Legal Action? Yes No    
if you answered Yes to Bankruptcy, Repossession or Defendant In A Legal Action, please explain below

Nearest Relatvie Not Living With You:
Street Address:
City: State:
County: Zip:
Phone: Relationship:
Employment Information 
First Time Operator? Yes No     Time with CDL - Years: Months:     
Time as Owner / Operator - Years: Months:
Reason to Purchase: Additional Unit Replacement Unit             Buyer to Drive? Yes No
Driver Info if Other Than Buyer - Name:
Social Security #: CDL#: CDL State:
Type of Goods / Commodities Hauled:
Truck to be Titled in Personal or Business Name?
Where Will Truck Be Leased On?
Contact Person / Department at Your Lease: Phone Number for New or Current Lease:
References 
Current Employer / Haul Reference
Employer: Name:
Phone: How Long There? Driver Owner Operator
Previous Employer / Haul Reference
Employer: Name:
Phone: How Long There? Driver Owner Operator
Previous Employer / Haul Reference
Employer: Name:
Phone: How Long There? Driver Owner Operator
Financial Information 
Do You Have Your Own Authority? Yes No
Insurance Agent Name:
Insurance Agent Phone: ICC Number:
Number of Trucks Owned: Number of Trailers Owned:
Would You Like a Physical Damage Insurance Quote? Yes No
Would You Like a Liability Insurance Quote? Yes No
Current Truck Financed With:
Account #:
Year: Make: Model:
Finance Company Phone #: Trade? Yes No
Primary Bank: Phone:
Contact: Account Type:
Other Bank: Phone:
Contact: Account Type:
Other Lender Information
Lender 1: Account #: Year:
Make: Model:
Finance Company Phone #: Trade? Yes No

 

Lender 2: Account #: Year:
Make: Model:
Finance Company Phone #: Trade? Yes No

 

Lender 3: Account #: Year:
Make: Model:
Finance Company Phone #: Trade? Yes No

 

I certify the above information is correct to the best of my knowledge.
I agree to the Privacy Policy
By typing my name into the field below, the undersigned certifies that the information given above is true and complete and authorizes Price International, its subsidiaries and their assigns or potential assigns, or any other lender that this application is submitted to, to investigate the above information and the undersigned's accounts and credit experience. Price International credit experience and account information on the undersigned. This shall be a continuing authorization for all present and future disclosures of account information and credit experience on the undersigned by Price International, or any person requested to release such information to Price International. The undersigned has read and understood the Privacy Policy and the Disclaimer on the website this form was downloaded from.