TarasPort Trailers Credit Application

    Information about the Credit Applicant

    Legal Business Name (required)

    Your Name (required)

    Mailing Address

    County

    Phone (required)

    Fax

    Email (required)

    Equipment Location (if different from above)

    Type of Business

    Time in business as an owner/operator

    Business Type

    Fed. Tax ID #

    ICC or PUCO #

    Sales Tax Exempt?
    YesNo


    Information about the Company Principals (President, Owners or Partners)

    Principal1 Name

    Principal1 Title

    Principal1 Social Security #

    Principal1 Home Address

    Principal1Home Phone

     

    Principal2 Name

    Principal2 Title

    Principal2 Social Security #

    Principal2 Home Address

    Principal2 Home Phone


    Hauling References

    Company1 Name

    Address

    Phone

    Contact

     

    Company2 Name

    Address

    Phone

    Contact

     

    Insurance Agent

    Address

    Phone

    Contact


    Vendor/Equipment Information

    Name

    Phone

    Contact

    Name

    Fax

    Equipment to be purchased

     

    Condition
    NewUsed

    Term (months)

    Advance Payments

    Gross Amount

    Down Payment/Trade

    Total Cost (before tax)

     

    (REQUIRED) I hereby authorize the release of any credit reference information for the company and individuals listed above, including credit reports, loan, lease, checking, saving and trade accounts to Accord Financial Group and/or its assigns, and I warrant that the information stated above is true and correct.

    Date (MM/DD/YYYY): (REQUIRED)

    (Application is not complete until you click the Submit button.)