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Credit Application - Parts
Please fill out as completely as possible.
Purchaser/Business Information
Purchaser's Complete Name
First
Last
Middle
Company Name
Business Address:
City, State, Zip:
Business Phone:
Cell Phone:
Residence Phone:
Email Address:
Business Information:
Corporation
Partnership
Individual
Occupation / Business:
Number of Years in Business:
SSN/Corp. ID:
Name of Nearest Relative:
Relative's Address:
Relative's Phone:
Leased to (Name):
(Address):
Present Truck Purchased from:
How Financed::
CREDIT LIMIT REQUESTED:
Sales Tax::
Tax must be charged:
Yes
No
City Sales Tax No:
State Sales Tax No::
Do you use Purchase Orders:
Yes
No
Authorized Purchasers:
Bank/Mortgage Company Reference
*
Name/Contact:
Street Address:
City:
State:
Zip:
Phone Number
Account Number
Corporate Officers of Partnership, List Partners:
1.
Partner Name:
Partner Title:
2.
Partner Name:
Partner Title:
3.
Partner Name:
Partner Title:
Individual Owner:
*
Name:
Street Address:
City:
State:
Zip:
Residence Phone Number
Salesman's Name
CREDIT REFERENCES
(Minimum of three other than bank or revolving charge card accounts)
1.
Name/Contact:
Street Address:
City:
State:
Zip:
Phone Number
Account Number
2.
Name/Contact:
Street Address:
City:
State:
Zip:
Phone Number
Account Number
3.
Name/Contact:
Street Address:
City:
State:
Zip:
Phone Number
Account Number
TRUCKS OWNED
1.
Make:
Age:
Value:
Balanced Owing:
To Whom?:
2.
Make:
Age:
Value:
Balanced Owing:
To Whom?:
3.
Make:
Age:
Value:
Balanced Owing:
To Whom?:
4.
Make:
Age:
Value:
Balanced Owing:
To Whom?:
5.
Make:
Age:
Value:
Balanced Owing:
To Whom?:
6.
Make:
Age:
Value:
Balanced Owing:
To Whom?:
Prior Bankruptcy:
Yes
No
Prior Judgements:
Yes
No
Prior Tax Liens:
Yes
No
Pending Lawsuits:
Yes
No
Salesperson's Name
I (We) authorize Omaha Truck Center, Inc. to make whatever credit inquiries it deems necessary in connection with this Credit Application or in the course of review or collection of any credit extended in reliance on this application and instruct any person or consumer reporting agency to compile and furnish Omaha Truck Center that it may have or obtain in response to such credit inquires and agree that such information, along with this application shall remain Omaha Truck Center property whether or not credit is extended. I (We) hereby agree to cooperate in consideration of this privilege by making settlement on or before the Tenth of the Month following purchase. Should payment not be made accordingly, it is understood the amount will be subject to being placed on a CASH BASIS. Accounts not paid within 30 days from the date of sale shall be considered past due and charged interest at a rate of 16% per annum.
Signature
Either Submit this application or print the form and mail it to us. Thank You!
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