200 Industrial Way Benicia, CA 94510 |
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(707) 748-4498
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200 Industrial Way Benicia, CA 94510 |
VIEW ON MAP
(707) 748-4498
Nor Cal Truck Sales & Mfg.
Application for Financing
Please complete this form and we will be in touch shortly.
PURCHASER INFORMATION
Legal Company Name
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Business Phone
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Address
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Street Address
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ZIP Code
Fax
Cell Phone
Email Address
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Federal Tax ID Number
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Years in Business
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No. of Trucks in Fleet
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State of Incorporation
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Choose
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PROPRIETORSHIP
CORPORATION
PARTNERSHIP
LIMITED LIABILITY CO
Principal #1- Name
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Title
Address
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Armed Forces Americas
Armed Forces Europe
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ZIP Code
Home Phone
Cell Phone
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Social Security Number
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Principal #2- Name
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Title
Address
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Street Address
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Alaska
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Arkansas
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Delaware
District of Columbia
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Georgia
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Cell Phone
*
Social Security Number
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Birthdate
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Years of Industry Experience
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TRUCK USAGE
Years as Owner/Operator
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Your License Number
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Expiry Date
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State
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Purchaser to Drive?
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Yes
No
*If No, Please Provide Driver Information Below
Driver Info
Driver's Full Name
Experience Years
Social Security Number
Driving License Number
Expiry Date
Month
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1921
1920
State
Driver's Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Company Name for Truck Work
Off-Highway Use
Yes
No
Average Miles Per Month
Company Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
If Trucking - Between What Points
Broker Contact
CONTRACT HELD
With Whom?
Contact Name
Contact's Telephone
Years Effective
INSURANCE
Insurance Company
Agent
Policy Number
Telephone
BANK/FINANCIAL ACCOUNTS
Name of Bank or Financial Institutions
Account Type
Savings
Checking
Account Number
Telephone
FINANCE REFERENCES
Name
Address
Account #
Telephone
Name
Address
Account #
Telephone
Name
Address
Account #
Telephone
The Undersigned, who is either a principal of the credit applicant, or a guarantor of its obligations-recognizing that his or her individual credit history may be a factor in the evolution of the credit history of the applicant-authorizes and consents to Nor-Cal Truck Sales & Mfg., Its nominees or its assigns, to review his/her personal credit from a National Credit Bureau. This authorization extends to obtaining ratings from listed banks and trade references. Such authorization shall extend to obtaining a credit profile in consideration of this application and subsequently for the purpose of an update, renewal, or the extension of additional credit is requested. A fax or photocopy of this authorization is to be accepted as an original.
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Date
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