Truck Credit Application

STATEMENT OF CONSENT
Application Date*
Date Format: MM slash DD slash YYYY
I certify that the information provided by me is correct. I also understand that you will be checking with credit reporting agencies. I authorize an investigation of my credit and employment history and the release of information about my credit experience. Please initial below to indicate that you have received a copy of our Privacy Notice and agree to all of the above. YOUR CREDIT APPLICATION IS GOING THROUGH A SECURE WEBSITE AND YOUR IDENTITY IS SAFE To complete the application, a valid email account or valid driver’s license will be required to verify authenticity of the individuals applying for credit and to protect individuals from identity theft. By signing, the applicant(s) submits the below information for the purpose of obtaining credit and represents that all such information is true and accurate. Each of the undersigned person(s) authorize Jim’s Pacific Garages, Inc. and/or its assignees/designees permission to obtain consumer credit reports relating to their individual credit history.*
I agree to the statement above.
Signature*
(Initial here)*
Are you currently working with a salesperson?*
- Yes
- No

VEHICLE INFORMATION
Agent*
Stock Number
Condition
Year*
Make*
Model
Price
VIN
Down Payment

YOUR CONTACT INFORMATION
Name As It Appears on Drivers License
First Name*
Middle Name
Last Name*
Driver's License*
Work Phone
Phone*
Email*
Social Security Number*
Marital Status
Date of Birth
Do you have a CDL?*
How long have you had a CDL?*

PHYSICAL ADDRESS INFORMATION
Address*
Street Address City State ZIP Code

HOUSING INFORMATION
Do you Rent or Own your home, or other?*
LandLord / Mortgage Holder*
Rent / Mortgage Monthly Amount
Mortgage Balance
Time at Current Residence
Year*
Month*

PREVIOUS RESIDENCE (IF LESS THAN 5 YEARS AT CURRENT RESIDENCE...)
Address
Street Address City State ZIP Code
How long at Previous Residence
Year
Month
BANKING INFORMATION
Name of Bank Account Types City State Phone#

BUSINESS INFORMATION
Is this loan to be in under a company name?
- Yes
- No
Business Name
Address
Street Address City State ZIP Code
Phone
FEIN
Years in Business

HAULING REFERENCES
Company Details*
Name of Company Contact at Company Phone Commodity Hauled? Hauling Local or Nationwide?

PRIOR TRUCK PURCHASES
First Time Buyer?
- Yes
- No
Have you ever financed?
- Yes
- No
Is purchase a replacement or addition?
Year
Make
Model
Financed By
Date Financed
Have you ever filed bankruptcy?
Are you a defendant in any legal action?
Have you had any item repossessed?
- Yes
- No
If yes, please explain below
How Many Trucks Do You Own*
MC#
Name
This field is for validation purposes and should be left unchanged.

News & Specials

Google Reviews

I needed help with the right light fixture for my truck. Kyle took the time to walk out to my truck to look. Showed me the right one, installed it by popping it in, and showed mor how to do it myself next time! I appreciate it very much.

VIRGINIA Blacksmith

21:28 20 Sep 19

They have good service. Get you going quick

Rexford Rothery

01:31 20 Jul 19

Great service and amazing staff

Rosey Seeliger

16:48 04 Sep 19

Very friendly,helpful and nice staff !!

Marius S

00:52 18 Oct 19

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›

News & Specials

Google Reviews

VIRGINIA Blacksmith

21:28 20 Sep 19

They have good service. Get you going quick

Rexford Rothery

01:31 20 Jul 19

Great service and amazing staff

Rosey Seeliger

16:48 04 Sep 19

Very friendly,helpful and nice staff !!

Marius S

00:52 18 Oct 19

‹

›

News & Specials

Google Reviews

VIRGINIA Blacksmith

21:28 20 Sep 19

They have good service. Get you going quick

Rexford Rothery

01:31 20 Jul 19

Great service and amazing staff

Rosey Seeliger

16:48 04 Sep 19

Very friendly,helpful and nice staff !!

Marius S

00:52 18 Oct 19

‹

›

Step 1 of 9 - STATEMENT OF CONSENT

STATEMENT OF CONSENT

VEHICLE INFORMATION

YOUR CONTACT INFORMATION

PHYSICAL ADDRESS INFORMATION

HOUSING INFORMATION

Time at Current Residence

PREVIOUS RESIDENCE (IF LESS THAN 5 YEARS AT CURRENT RESIDENCE...)

How long at Previous Residence

BUSINESS INFORMATION

HAULING REFERENCES

PRIOR TRUCK PURCHASES

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News & Specials

Recent Posts

Google Reviews

Connect With Us

Inventory Links

Quick Links

News & Specials

Recent Posts

Google Reviews

Connect With Us

Inventory Links

Quick Links

News & Specials

Recent Posts

Google Reviews

Name of Bank	Account Types	City	State	Phone#

Name of Company	Contact at Company	Phone	Commodity Hauled?	Hauling Local or Nationwide?