Financing

Financing

Current Monthly Gross

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Date of Birth *

MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Personal Financial Information

Amount available for down payment

Credit Score Estimate *Choose One300-499500-600601-660661-780781-850

Have you ever filed for bankruptcy? *Choose OneYesNo

Ever had a repossession? *Choose OneYesNo

Housing Status *HomeownerRentFamilyOther

How many years have you lived at your current address? *

What is your monthly rent/mortgage? *

Citizenship Status *U.S. CitizenWork VisaGreen Card/Permanent Resident

Business Ownership

Do you own a business? *Choose OneYesNoNo, I am a company driver

What kind of business do you own?Choose OneI own a C CorpI own an S CorpI own an LLCI am a Sole ProprietorI am part of a partnership

Business Name *

Your Business Title *

Percent of Ownership *

Federal Tax ID

Business Start Date

State where your business is incorporatedChoose OneAlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming

Are you tax exempt?YesNo

Average Business Bank Balance

Business Address

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Work History

Current PositionChoose OneCompany DriverOwner OperatorBusiness OwnerNot currently working

Do you have a CDL?Choose OneYesNo

First time Owner Operator? *Choose OneYesNo

Where do you drive? *Choose OneDrop-LocalRegionalOTR

Total years driving experience? *

Years as Owner Operator? *

Years as a company driver? *

Hazmat? *Choose OneYesNo

What do you haul?

Carrier Information

Current Carrier

Years at Carrier

Current Monthly Gross

Current Carrier Contact Name

First

Last

Current Carrier Phone Number

Are you planning on changing carriers?Choose OneYesNo

New Carrier Name

New Carrier Number

Do you operate under your own authority? *Choose OneYesNo

DOT Number

Garage Name

Garage Address

Fleet Information

Have you previously owned a truck or trailer?Choose OneYesNo

Lender Name

Original Loan Amount

Amount Owed

Purchase TypeChoose OneReplacing EquipmentAdding Equipment

Type of OwnerChoose OneSingle Unit Owner OperatorMulti Unit/Fleet Owner

Number of Trucks In Fleet

Number of Trailers In Fleet

Estimated Value of Fleet

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