Credit Application

    Business Type:

    DOT #

    FEIN #

    Borrower:

    Social Security #

    Date of Birth

    Contact Name & Title (If Corporation or LCC)

    Cell Phone:

    Email:

    Office Phone:

    Physical Address:

    City, State, Zip Code:

    Time at Address

    years

    Have you filed bankruptcy?

    Are you a defendant in any legal action?

    Have you had any items repossessed?

    If answer is YES to any of the above, provide details:

    Driving Experience & Owned Equipment

    Driving Experience

    years

    Owner Operator Experience

    years

    Fleet Size: # of Tractors Owned

    Fleet Size: # of Trailers Owned

    IRP #

    IFTA #

    Tractor & Trailer Lenders (Optional)

    Lender Name

    Date Account Opened

    Phone Number

    Haul Sources (Optional)

    Company or Broker Name

    Time With Company

    Contact

    Phone Number

    years

    years

    If less than 2 years of haul history with the above sources, list your previous employer or haul references:

    Balance Sheet (Optional)

    Assets

    Cash on hand and in bank

    $

    Owned Commercial Tractors & Trailers

    $

    Monthly Rent/Mortgage Payment

    $

    Total Assets

    $

    Liabilities

    Credit Card Balances Due

    $

    Commercial Equipment Loans

    $

    Mortgage Balance

    $

    Total Liabilities

    $

    Sales Representative

    Sales Representative

    • Not Applicable

    • Barry Hansen

    • Jacob Endsley

    • Jeremy Galata

    • Jon Holdorf

    • John Brodie

    • Leo Lazarte

    • Mike Fisher

    • Spencer Deputy

    • Thomas Barra

    • Tim Chezem

    • Ron Dietz

    For the purposes of establishing and maintaining credit, the undersigned submits the forgoing statement and information contained on this sheet, both written and printed, and including supplemental sheets, if any, as being a full, true, and correct statement of my financial condition and all above matters, on the date stated. The undersigned agrees to notify Utility Trailer sales of Utah, Inc, and any affiliates which have or intend on providing credit or financing, immediately in writing of any materially unfavorable change in my financial condition of the above matters, and in the absence of such notice or a new and full written statement, all matters herein may be considered as a continuing statement and substantially correct. The undersigned hereby authorizes Utility Trailer Sales of Utah, Inc. and/or its designee, nominees, assignees or potential assignees to make inquiry into, to request, to obtain credit reports, and to receive any information concerning my character, general reputation, personal characteristics, mode of living, and all information from creditors which Utility Trailer Sales of Utah, Inc. and/or any of its affiliates deems relevant for the granting and collection of the proposed borrowing or credit account. This authorization shall be effective from the date upon which this application is signed and is a continuing authorization for all present and future disclosures of account information and credit experience on Applicant made by Utility Trailer Sales of Utah, Inc. and/or its designee, nominees, assignees or potential assignees, or any person requested to release such information to Utility Trailer Sales of Utah, Inc. and/or its designee, nominees, assignees or potential assignees. Upon my request, additional information as to the scope of this inquiry, if one is made, will be provided. I further represent 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; nor no such person has been convicted of any felony. I understand that Utility Trailer Sales of Utah, Inc. and/or its designee, nominees, assignees or potential assignees, or any person requested to release such information to Utility Trailer Sales of Utah, Inc. and/or any of its designated affiliates will be relying on the accuracy of the matters set forth herein as a basis for extending any credit which I may receive.

    Signature

    Title

    Date

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