Credit Application

Please include the following financial information with this application:(Required)

2 years of federal tax returns

3 months of interim financial statements

File(Required)

Drop files here or

Max. file size: 30 MB, Max. files: 2.

Company Overview

Company Name (as registered with the state)

Company Name

DBA:

Physical Address:(Required)

Street Address City State / Province / Region ZIP / Postal Code

Mailing Address:(Required)

Street Address City State / Province / Region ZIP / Postal Code

Website Address

Email(Required)

Entity Type(Required)

Federal Tax ID(Required)

Date of Incorporation:

Nature of Business/Operations:

Shareholders’ Equity

Name

Title

Date Joined

% of Ownership

Customer Base/Contracts

Company

Contact

Phone

% of Revenues

Commercial Trade References

Reference

Contact

Phone

Account #

Current Fleet

How many trucks do you have in your fleet?(Required)

This is my first truck(Required)

Yes

Is this truck an addition or a replacement?(Required)

Additional Unit

Replacement Unit

Have you ever had a repossession?(Required)

Yes

Ever filed for Bankruptcy?(Required)

Yes

If yes, please explain circumstances:

Fleet Financing References

Financial Institution

Contact

Phone

Account

Balance

Guarantors/Ownership Information

Principal Name(Required)

Phone(Required)

Email(Required)

Home Address(Required)

Social Security Number(Required)

Date Of Birth(Required)

Monthly Income(Required)

Mortgage/Rent(Required)

Own

Rent

Time at Residence:(Required)

Guarantors/Ownership Information

Principal Name(Required)

Phone(Required)

Email(Required)

Home Address(Required)

Social Security Number(Required)

Date Of Birth(Required)

Monthly Income(Required)

Mortgage/Rent(Required)

Own

Rent

Time at Residence(Required)

Guarantors/Ownership Information

Principal Name

Phone

Home Address

Social Security Number

Date Of Birth

Monthly Income

Mortgage/Rent

Own

Rent

Monthly Income

Guarantors/Ownership Information

Principal Name

Phone

Home Address

Social Security Number

Date Of Birth

Monthly Income

Mortgage/Rent

Own

Rent

Monthly Income

Commercial Banking Information

Bank Name(Required)

Contact(Required)

Phone(Required)

Account(Required)

Check all that apply

Checking/Savings

Working Line of Capital

Term Loans

Mortgage

I (We) authorize DTI Trucks or its designee(s), assignee(s), or any lending source to whom this application is submitted (“You”) to obtain, review or investigate all credit information, including but not limited to consumer credit reports, bank and trade references and accountant information for purposes of processing this lease credit application. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. All principals hereto agree that an electronic copy of this application may be treated as and considered the same as an original, including the signature(s) below. By providing my contact information, I agree to receive electronic communications from You. I (We) certify that the above information provided is true and correct.

Signature

Print Name

First

Date

Signature

Print Name

First

Date

Signature

Print Name

First

Date

Signature

Print Name

First

Date

Company Overview

Current Fleet

If yes, please explain circumstances:

Guarantors/Ownership Information

Guarantors/Ownership Information

Guarantors/Ownership Information

Guarantors/Ownership Information

Commercial Banking Information

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