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Jukonski Truck Sales Credit Application

Applicant Information 

NAME - First: Middle: Last: Jr. Sr.
Social Security #: Fed Tax ID#: DBA LLC INC.
Business Name: % Ownership: DOB:

Current Mailing Address

Street Address:
City: State: Zip:
County:

Physical Address (if different from mailing address)

Street Address:
City: State: Zip:
County:

Additional Information

Business Phone: Cell Phone: Fax: Email:
Own Home? Yes No     If Yes, how many years?
Ever Files Bankruptcy? Yes No
Ever Had Repossession? Yes No
Are You A Defendant In A Legal Action? Yes No    
if you answered Yes to Bankruptcy, Repossession or Defendant In A Legal Action, please explain below

Nearest Relatvie Not Living With You:
Street Address:
City: State:
County: Zip:
Phone: Relationship:

Employment Information


First Time Operator? Yes No     Time with CDL - Years: Months:     
Time as Owner / Operator - Years: Months:
Reason to Purchase: Additional Unit Replacement Unit             Buyer to Drive? Yes No
Driver Info if Other Than Buyer - Name:
Social Security #: CDL#: CDL State:
Type of Goods / Commodities Hauled:
Truck to be Titled in Personal or Business Name?
Where Will Truck Be Leased On?
Contact Person / Department at Your Lease: Phone Number for New or Current Lease:

References


Current Employer / Haul Reference
Employer: Name:
Phone: How Long There? Driver Owner Operator
Previous Employer / Haul Reference
Employer: Name:
Phone: How Long There? Driver Owner Operator
Previous Employer / Haul Reference
Employer: Name:
Phone: How Long There? Driver Owner Operator

Financial Information


Do You Have Your Own Authority? Yes No
Insurance Agent Name:
Insurance Agent Phone: ICC Number:
Number of Trucks Owned: Number of Trailers Owned:
Would You Like a Physical Damage Insurance Quote? Yes No
Would You Like a Liability Insurance Quote? Yes No
Current Truck Financed With:
Account #:
Year: Make: Model:
Finance Company Phone #: Trade? Yes No
Primary Bank: Phone:
Contact: Account Type:
Other Bank: Phone:
Contact: Account Type:

Other Lender Information

Lender 1: Account #: Year:
Make: Model:
Finance Company Phone #: Trade? Yes No

 

Lender 2: Account #: Year:
Make: Model:
Finance Company Phone #: Trade? Yes No

 

Lender 3: Account #: Year:
Make: Model:
Finance Company Phone #: Trade? Yes No

 

I certify the above information is correct to the best of my knowledge.
By typing my name into the field below, the undersigned certifies that the information given above is true and complete and authorizes Jukonski Truck Sales, its subsidiaries and their assigns or potential assigns, or any other lender that this application is submitted to, to investigate the above information and the undersigned's accounts and credit experience. Jukonski Truck Sales credit experience and account information on the undersigned. This shall be a continuing authorization for all present and future disclosures of account information and credit experience on the undersigned by Jukonski Truck Sales, or any person requested to release such information to Jukonski Truck Sales. The undersigned has read and understood the Privacy Policy and the Disclaimer on the website this form was downloaded from.


 

 

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