Email : ar@peterbilttpe.com
Call Us : (775) 336-5327
Credit Application

Convenient credit to keep your trucks from interfering with business.

Fill out and submit this form to apply for credit with PacLease.

CUSTOMER INFORMATION

Company Name*
Trade/DBA Name*

Physical Address*

Phone*
[text* your-phone*]
Email*
FAX
Tax ID*
Entity Type*
 Corp Partnership Sole Proprietor S-Corp LLC LLP Non-Profit Government
State Formed*
Date Formed*
Other businesses owned or affiliated
Type of Business*
 For Hire Trucking Private Fleet Vocational/Work Truck Services Lease/Rental Municipality

Business Owner(s) and Corporate Officers - Attach additional pages if necessary.

Name
SSN
Date of Birth

Address

Applicant to drive this purchase?*
 Yes No
Applicant first time owner/operator?*
 Yes No
If no, who will drive?
Applicant truck driving experience*

Applicant owner/operator experience*

Titling State*
Type of Goods Hauled*
# Medium Duty Trucks
# Heavy Duty Trucks
# Trailers
# Leased
Is this additional equipment?*
 Yes No
Have you ever filed bankruptcy?*
 Yes No
Are you a defendant in any legal action?*
 Yes No
Have you ever had an item repossessed?*
 Yes No
Will any of your Equipment be domiciled or operate within 100 miles of Mexico more than 25% of the annual miles?
 Yes No
Do you or any of your Equipment ever operate outside of the United States?
 Yes No
Is screening completed on drivers prior to employment?
 Yes No
Will payments originate from non-U.S. locations?
 Yes No
Please list all countries in which the applicant, its affiliated, and subsidiaries conduct activites or have assets located

REFERENCES

Bank (business)*
Account #*
Phone #*
Contact*
Bank (personal)*
Account #*
Phone #*
Contact*
Finance Company*
Phone #*
Contact*
Equipment (Yr/Make/Model)*
Account*
Finance Company*
Phone #*
Contact*
Equipment (Yr/Make/Model)*
Account*

HAUL SOURCES

Business Name*
Phone #*
Contact*

Business Address*

Gross Monthly Income*
Time with Business (Years - Months)*
Truck to work for this haul source?*
 Yes No
Off Highway Use?*
 Yes No
Commodities Hauled*
Hauled between what points*

Please attach financial statements which include Profit and Loss Statements for the last two years certified by an officer of the company as being full, true and accurate.



For the purpose of establishing and maintaining credit, the undersigned submits the foregoing statement and information contained on this sheet, both written and printed, and including supplemental sheets if any, as being a full, true, and correct statement of my financial condition and all above matters, on the date stated. The undersigned agrees to notify you immediately in writing of any materially unfavorable change in my financial condition of the above matters, and in the absence of such notice or of a new and full written statement, all matters herein may be considered as a continuing statement and substantially correct. The undersigned hereby authorizes Peterbilt Truck Parts & Equipment, LLC (PTPE), and/or its related entities (collectively, Peterbilt Truck Parts & Equipment LLC (PTPE), to obtain credit information from the above listed references and from any credit-reporting agency. Each of the undersigned person(s), individually and on behalf of the above Applicant (collectively the signer), hereby represents to PTPE that (a) all information provided to PTPE in connection with this credit application, including, without limitation, tax returns, financial statements, accountants' statements and the information set forth above, is true and correct and (b) this credit application is made solely in connection with a commercial (and not a person, family or household) transaction. Signer hereby authorizes PTPE and any of its affiliates and potential or actual assignees to obtain any business and/or personal financial information, from time to time, including. without limitation, information from any consumer reporting agency, credit bureau or other reporting source regarding Signer's and/or applicant's credit history, for purposes of (i) evaluating this application, (ii) monitoring any and all leases, loans and other financial transactions entered into as a result of this application, (iii) extending, renewing or amending any such lease, loan or other contract, and/or (iv) evaluating any request by Signer or Applicant for additional credit in the future. Signer hereby authorizes and instructs any consumer reporting agency, financial institution and other persons or entities possessing information about Signer and/or Applicant to furnish PTPE with all such information in response to an inquiry from PTPE both now and at any time in the future. I further authorize PTPE to provide this application to third parties for the purpose of providing credit or financing to me and I authorize any actual or proposed third party financing sources to obtain credit information from the above listed references and from any credit reporting agency. This authorization shall be effective from the date upon which this application is signed and is extinguished automatically upon full payment of the present borrowing, if any is granted. Upon my written request, additional information as to the scope of this inquiry, if one is made, will be provided. I further represent that neither the undersigned, any principal officer of the undersigned, nor any contemplated operator of any equipment proposed to be purchased has any record or reputation of having violated any federal or state laws relating to liquor, narcotics or contraband, and no such person has been convicted of any felony. I understand that PTPE and/or Seller of motor vehicle, parts, or services to whom this application is presented, will be relying on the accuracy of the matters set forth herein as a basis for extending any credit which I may receive and that the granting of such credit shall be in PTPE's sole and absolute discretion. The undersigned further acknowledges that PTPE may condition the award of credit on receipt of a personal guaranty by a suitable individual or individuals.

Signature*
Date*
Signature*
Date*



Contact Us
2272 Larkin Circle
Sparks, NV 89431
Phone : (775) 336-5327
Email : ar@peterbilttpe.com

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