CSMF Credit Application | CSM Companies, Inc.

Customer Information - Buyer
Name*
First Middle Initial Last
Doing Business As
Buyer Social Security Number*
Date of Birth*
Marital Status
Number Of Dependents
Buyer Street Address*
Street Address Address Line 2 City State ZIP Code
How Long At Current Address*
Homeowner?*
- Yes
- No
Monthly Rent/Pmt*
County*
Business Address Different Than Above?*
- Yes
- No
Business Address
Street Address Address Line 2 City State ZIP Code
Business Phone*
Mobile Phone*
Fax Number
Email Address*
Business Legal Name
Tax ID Number/FEIN*

Income Sources / Driving History (5 years)
Employer Name*
Contact Name At Employer
Phone*
Position
How Long?*
Employer Name (Previous)*
Contact Name At Employer
Phone*
Position
How Long?*

Financial Disclosures
Have you ever taken bankruptcy?*
- Yes
- No
Are you a defendant in any legal action?*
- Yes
- No
Have you ever had any item repossessed?*
- Yes
- No
Are any accounts past due?*
- Yes
- No
If you answered yes (above), please explain (attach additional sheet if necessary)*
Nearest Relative (Not living with you)*
First Last
Relationship*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code

Banking, Truck Financing, Real Estate and Other Installment Credit Information
Lender/Institution Name*
Phone
Account Number
Balance
Value
Year/Make/Model
Lender/Institution Name*
Phone
Account Number
Balance
Value
Year/Make/Model
Lender/Institution Name*
Phone
Account Number
Balance
Value
Collateral

Equipment Purchase
Year*
Make*
Model*
VIN or Stock #*
Purchase Price*
Cash Down Payment Available*
New or Used?*
- New
- Used
Monthly Payment Desired*
Length of Financing Desired*
Trade-in?*
- Yes
- No
Year, Make, Model*
Trade Value*
Balance Owed*

Authorized Signature
By signing below and submitting this application, the undersigned (“Applicant”) submits the foregoing statement and information contained on this sheet and supplemental sheets, if any, as being a full, true, and correct statement of my financial condition and all above matters, on the date stated. I/we further certify that any lease of financing that may result from this application, and any vehicle so leased or financed, will be used exclusively for Applicant’s business or commercial purposes and I understand that this application will be retained regardless of whether it is approved. The Applicant hereby authorizes CSM Financial, LLC and its assigns or nominees (collectively “Lender”) to make inquiry into, to request, and to receive any information concerning my character, general reputation, personal characteristics, mode of living, and all information from creditors which Lender deems relevant for the granting and collection of the proposed borrowing. This authorization shall be effective from the date upon which this application is signed and/or transmitted via electronic means to Lender. Upon my written request, additional information as to the scope of this inquiry, if one is made, will be provided. Applicant further represents that neither the undersigned, any principal officer of the undersigned, nor any contemplated operator of any equipment proposed to be purchased has any record or reputation of having violated any federal or state laws relating to liquor, narcotics or contraband, and no such person has been convicted of any felony. Applicant understands that Lender, and/or Seller of motor vehicle, parts or services to whom this application is presented, will be relying on the accuracy of the matters set forth herein as a basis for extending any credit which I may receive. If this application is submitted online, Applicant further certifies that all information provided in this online credit application is true and complete. I authorize Lender to rely on this information to make inquiries for the purpose of evaluating and verifying this online credit application, including obtaining consumer reports from any consumer reporting agency and contacting my employer. If Lender grants my request for credit and I sign a loan or lease agreement, I also authorize and give consent to the Lender to obtain my consumer report from any consumer reporting agency at any time during the life of my loan or lease for any purpose, including but not limited to times when I ask the lender to defer my payment(s) or extend my payment due date(s) under my loan or lease agreement, in connection with any action related to collection of my loan or lease, or for other legitimate purposes associated with my loan or lease.
Signature Here*
Date*
Name
This field is for validation purposes and should be left unchanged.

CSM Financial Credit Application

Step 1 of 7

Customer Information - Buyer

Truck Ownership & Usage

Income Sources / Driving History (5 years)

Financial Disclosures

Banking, Truck Financing, Real Estate and Other Installment Credit Information

Equipment Purchase

Authorized Signature

CSM Financial Credit Application

Step 1 of 7

Customer Information - Buyer

Truck Ownership & Usage

Income Sources / Driving History (5 years)

Financial Disclosures

Banking, Truck Financing, Real Estate and Other Installment Credit Information

Equipment Purchase

Authorized Signature

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