Credit Application - Bush Truck Leasing

APPLICATION INFORMATION

Type of Unit

Terminal City

Terminal #

Contract Company

Business / Corp. Name

EIN/Federal Tax ID #

Contract Company Name

PERSONAL INFORMATION

Name

First Name

Middle Initial/Name

Last Name

Suffix

Birth Date

mm/dd/yyyy

Social Security

Marital Status

Drivers Licence - State

Drivers License

CONTACT INFORMATION

Phone

Cell phone

Email

Confirm Email

CURRENT ADDRESS

Address

Address (line 2)

City

State

Zip Code

Years at Address

Months at Address

County

Home Status

Monthly Payment

EMPLOYMENT HISTORY

Company Currently Contracted With

Years Worked

Months Worked

# of Routes

# Trucks

Name of Current Company

EMPLOYER 1

Previous Employer/Company Contracted With

Years Worked

Months Worked

EMPLOYER 2

Previous Employer/Company Contracted With

Years Worked

Months Worked

Additional Comments

0 of 2000 max characters

I/We affirm my/our identity and authorize Bush Truck Leasing, Inc. and/or its Lenders/Corporate Sponsors to investigate my/our credit history. Upon request from Bush Truck Leasing, I/we authorize any credit grantor to release to Bush Truck Leasing, Inc. and/or its Lenders/Corporate Sponsors, my/our credit record. A Photostat or facsimile of this authorization shall be as valid as the original.

Please click signature field, indicating the above information is correct. Checking of this field indicates your approval and acts as a signature.

Signature

SIGNATURE