Credit Application

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Applicant Personal Information
*Required Fields
   
* First Name
Middle Initial
* Last Name
Suffix
* Email
* You are Individual Partnership Corporation
* Social Security #
* Date of Birth
* Street Address
* City
* State
* Zip Code
* Phone #
Mobile #
County
How long there (years)
Time in area (years)
Home Owner Yes No
   
Previous Address
City
State
Zip Code
Years at previous address
   
Nearest Relative NOT living with you
Address
Phone
Relationship
   
* Have you ever taken Bankruptcy Yes No
If yes, please explain
* Are you a defendant in a legal action? Yes No
If yes, please explain
* Have you ever had a Repo? Yes No
If yes, please explain
 

Employment
* First Time Owner Operator? Yes No
Time as Owner Operator(years/months)
* Time as driver (years/months)
* Reason Add't Unit Replacement
* Buyer to Drive? Yes No
If other than buyer, List Driver's Name
 
Your Business Name or DBA
Tax I.D. #
# Currently own Trucks Trailers
Name truck will be titled in
 
Base Plate in what state?
Titled in what state?
 
Truck to work for (company)
Phone
Contact Person
How long there
Position held
 
Previous employer
Phone
How long there
Position held
 

Financial Information

* Name of Bank
* Branch
Contact Phone #
 
Previous truck financed with
Phone
Year/Make of truck
Date paid off
 
Previous truck financed with
Phone
Year/Make of truck
Date paid off
 
* Cash in Checking/Savings $
Credit Card debts owed to
Amount owing
 
Trucks owned
Trucks financed by
Amount owing
 
Other assets
Other debts
Amount owing


The Applicants represent and warrant that all credit and financial information submitted to Stevens Transport, Inc. is true and correct and that Stevens Transport, Inc. AND OR ITS NOMINEES ASSIGNS OR PARTICIPATING LENDERS may obtain any credit information necessary pertaining to this application.
Submitting this questionnaire is equivalent to a signature.

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