Credit Application

APPLICATION INFORMATION

Type of Unit *

Contract Company *

Terminal City *

Terminal #

Business / Corp. Name *

EIN/Federal Tax ID #

PERSONAL INFORMATION

First Name *

Middle Initial

Last Name *

Suffix

Birth Date *

Social Security *

Marital Status *

Email *

Drivers License *

Drivers Licence - State Issued *

CURRENT ADDRESS

Address *

City *

State *

Zip Code *

County *

Phone *

Cell

Home Status *

Monthly Payment

Years Lived at Address

Months Lived at Address

EMPLOYMENT HISTORY

Company Currently Contracted With *

# of Years Worked *

# of Months Worked

# of Routes *

# of Trucks in Fleet *

EMPLOYER 1

Previous Employer/Company Contracted With *

# of Years Worked *

# of Months Worked *

EMPLOYER 2

Previous Employer/Company Contracted With

# of Years Worked

# of Months Worked

Additional Comments

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