Custom Engineering the Most Profitable Trailer Solution
 
 
CREDIT APPLICANT INFORMATION

Legal Business Name/Applicant  (required)

Contact 

Address 

City    County

State    ZIP

Phone  (required)         Fax

Email 

Equipment Location (if different from above):

Type of Business:

Time in business as an owner/operator:

Corporation
Partnership
Proprietorship

 Federal Tax ID Number
 ICC or PUCO Number
 Sales Tax Exempt?
Yes
No
PRINCIPAL INFORMATION (President, Owner or Partners)
Name
 Title
 Social Security #
Home Address
 City, State, ZIP
 Home Phone
Name
 Title
 Social Security #
Home Address
 City, State, ZIP
 Home Phone
HAULING REFERENCES
Company
 Address
Phone
 Contact
Company
 Address
Phone
 Contact
Insurance Agent
 Address
Phone
 Contact
VENDOR/EQUIPMENT INFORMATION
Name
Phone
 Contact
Name
Fax
New
Used		 Term (months)
 Advance Payments
 Gross Amount
 Down Payment/Trade
 Total Cost (before tax)
(required) By checking this box, you 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. Applicant warrents that the information stated above is true and correct.
Date: (required)

Application is not complete until you click the Submit button.
 


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