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Locations
Inventory
Reduced Price Inventory
New Kenworth Trucks
New Mack Trucks
Pre-Owned Trucks
Pre-Owned <$50,000
All Truck Inventory
Companies
French Ellison Truck Center
Sahling Kenworth
Premier Leasing
Dedicated Fleet Services
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Premier Leasing Application for Rental or Leasing Account
Fleet Services
Premier Leasing Application Confirmation Page
CSM Financial Credit Application
Step 1 of 7
14%
Customer Information - Buyer
Name
*
First
Middle Initial
Last
Doing Business As
Buyer Social Security Number
*
Date of Birth
*
Marital Status
Single
Married
Widowed
Separated
Divorced
Number Of Dependents
Buyer Street Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Business Phone
*
Mobile Phone
*
Fax Number
Email Address
*
Business Legal Name
Tax ID Number/FEIN
*
Truck Ownership & Usage
Applicant To Drive This Purchase?
*
Yes
No
Applicant First Time Owner/Operator?
*
Yes
No
Applicant Truck Driving Experience
*
Years
Months
Applicant Owner/Operator Experience
*
Years
Months
Applicant Commercial Driver's License
Yes
No
Issue State
Issue Date
Number of Units Operated
*
Average Annual Miles
Commodities Hauled
Replacement or Addition?
*
Replacement
Addition
Truck To Work For? (If different than present employer)
State of Titling
Off Highway Use?
Yes
No
Between What Points?
Revenue Per Mile
Trailers Owned?
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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
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
*
Comments
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