freightliner credit application

SelecTrucks


The First-Time Buyer Online Quick Credit Form Click here for Print and Fax Long Credit Application
Describe truck of interest:
Full Name:
Address:
City:
State.:
Zip:
Home Phone:
Cell Phone:
Years at above address:
Date of Birth:
Email
Social Security:
Drivers License:
Drivers License State:
Years of Driving Exp:
Years as O/O:
Monthly Payment or Rent:
Prior Bankruptcy?	When?
Prior Repossessions?	When?
Lawsuits Pending?
Tax Liens?
Driving Experience Most recent first
Company		Years
Phone:		Contact

Company		Years
Phone:		Contact

Company		Years
Phone:		Contact

*By submitting this application I give permission for SelecTrucks to order Credit Reports.

DISCLAIMER I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize any company that receives this application to cause to be conducted, at any time, an investigation of my background for credit purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, mode of living, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for credit gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information.

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