Fax completed and signed application to or e-mail to Phone No.:
Applicant (Corporations, LLCs & other organizations, use EXACT registered name)	Phone No.	Fax No.
Company Headquarters Office Address (Street Name, City, State, ZIP)	Tax ID No. (required)
Email Address	State of Organization
Corporation	LLC	Partnership	Sole Proprietorship	Individual	Date of Birth	Country of Citizenship	Non-U.S.: Passport #
Nature of Business (required):
Vendor Name (Supplier of Equipment)	Phone No.
Vendor Address	Fax No.
Equipment Location / Non-U.S. Activities
Will any of customer’s Equipment be domiciled or operate within 100 miles of Mexico more than 25% of the annual miles? No Yes
Does the customer or any Equipment ever operate outside of the United States? No Yes If yes, list all countries and complete Cross Border Activity Questionnaire:
Is screening completed on drivers prior to employment? No Yes If yes, what type of screen is completed?
Will payments originate from non-U.S. locations? No Yes If yes, list the countries from which the payments will originate:
Please list all countries in which the applicant, its affiliates, and subsidiaries conduct activities or have assets located:
New Equipment Purchase Used Equipment Purchase	Purpose:	Growth Replacement Refinance	Approx. Delivery Date:
Equipment Description (include model year, if used)	Equipment Price $
- Less Trade $
- Less Down Payment $
+ Doc Fee (standard doc fees apply) $
Insurance Agent	Phone No.	= Financed Amount $
Type of Financing Desired	Lease/Loan Term
Loan	Lease/Purchase ($1 Purchase / $101 in CA)	TRAC Lease (Vehicle)	Lease (Fair Market Value)	36	48	60
CREDIT INFORMATION
Years in Business:	No. of Employees:	Annual Revenue $
Largest Customer % of Sales %	Largest Customer Name
BANK REFERENCE
Bank Name	Banker name	Bank Account Number	Year Opened	Average Balance

BENEFICIAL OWNER AND GUARANTOR INFORMATION: Complete this section for all beneficial owners (individuals) with 25% or more in company ownership and all guarantors.
Beneficial Owner / Guarantor	SSN/Tax ID No.	% Company Ownership
Primary Address (Street Name, City, State, ZIP)	Phone No.	State of Organization
Corporation	LLC	Partnership	Individual	Date of Birth	Country of Citizenship	Non-U.S.: Passport #
Beneficial Owner / Guarantor	SSN/Tax ID No.	% Company Ownership
Primary Address (Street Name, City, State, ZIP)	Phone No.	State of Organization
Corporation	LLC	Partnership	Individual	Date of Birth	Country of Citizenship	Non-U.S.: Passport #
Beneficial Owner / Guarantor	SSN/Tax ID No.	% Company Ownership
Primary Address (Street Name, City, State, ZIP)	Phone No.	State of Organization
Corporation	LLC	Partnership	Individual	Date of Birth	Country of Citizenship	Non-U.S.: Passport #
Beneficial Owner / Guarantor	SSN/Tax ID No.	State of Organization
Primary Address (Street Name, City, State, ZIP)	Phone No.	Date of Birth
Corporation	LLC	Partnership	Individual	Date of Birth	Country of Citizenship	Non-U.S.: Passport #
COMPANY PRINCIPAL INFORMATION: Complete this section for one individual with significant responsibility for managing the legal entity such as: An executive officer or senior manager (e.g. Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, Managing Member, General Partner, President, Vice President, Treasurer); or Any other individual who regularly performs similar functions. Note: If appropriate, an individual listed above may also be listed in this section.
Name	SSN/Tax ID No.	Date of Birth
Home Address (Street Name, City, State, ZIP)	Country of Citizenship	Non-U.S.: Passport #
Has the Applicant, Beneficial Owner(s), Guarantor(s), or Principal(s) of the Applicant ever been convicted of a Felony? No Yes If yes, please explain:
Has the Applicant, Beneficial Owner(s), Guarantor(s), or Principal(s) of the Applicant ever filed for bankruptcy? No Yes If yes, date filed and please explain:
Signatures I certify that the information stated in this application is true and correct. I understand that you will retain this application whether or not it is approved. You and/or entities to whom you refer this application are authorized to check my credit and employment history (including criminal background checks), obtain insurance information and to answer questions about your credit experience with me. I authorize you and/or entities to whom you refer this application to contact my creditors and authorize any creditor so contacted to release to you such credit information as you may request. I further authorize you and/or entities to whom you refer this application to share this application and my information, including credit bureau reports and credit references, with potential purchasers or assignees of transactions that result from this application. PLEASE NOTE: At least one Beneficial Owner/Guarantor and all individual Guarantors listed above must sign this application. For additional Beneficial Owners/Guarantors, please provide information as shown above on a separate document.
Applicant Signature	Date
Applicant/Guarantor Signature	Date
Applicant/Guarantor Signature	Date
Applicant/Guarantor Signature	Date
Applicant/Guarantor Signature	Date

Notice to Applicants and Guarantors: To help the government fight the funding of terrorism, narcotics trafficking, trans-national organized crime, and money laundering activities, U.S. Federal law requires financial institutions to obtain, verify, and record information that identifies each person (individuals or businesses) who opens an account. What this means for you: When you open an account or add any additional service, we will ask you for your name, address, and taxpayer identification number that will allow us to identify you. We may also ask to see other identifying documents and information relating to beneficial owners and we may verify compliance by you and other beneficial owners with requirements of U.S. Federal laws.