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PLEASE USE ANY ADDITIONAL SHEETS WHERE NECESSARY FOR ANY SECTION. IF YOU ARE UNSURE HOW TO FILL THIS FORM OUT USING YOUR PC, FEEL FREE TO CALL US AND WE WILL ASSIST YOU.
Shelby Elliotts Used Trucks Inc
475 Western Drive, Sikeston, MO 63801 - Office: 573-471-2100 Fax: 573-471-2133
www.shelbyelliott.com Email: finance@shelbyelliott.com
Credit Application
Complete the Following If Vehicle to be Titled in Business Name:
* BUSINESS NAME * BUSINESS TYPE (LLC, S-CORP, C-CORP) STATE OF INCORPORATION DATE OF INCORPORATION FEDERAL TAX ID NUMBER NAMES OF BUSINESS SIGNER(S)
Applicant Information:
* FIRST NAME * MIDDLE NAME * LAST NAME *DATE OF BIRTH # DEPENDANTS * SOCIAL SECURITY NUMBER
Co-Applicant Information:
* FIRST NAME * MIDDLE NAME * LAST NAME *DATE OF BIRTH # DEPENDANTS * SOCIAL SECURITY NUMBER
* MARITAL STATUS
* MARITAL STATUS
SINGLE
* STREET, CITY, STATE, ZIP CODE
MARRIED
DIVORCED
WIDOWED
* COUNTY
SINGLE
* STREET, CITY, STATE, ZIP CODE
MARRIED
DIVORCED
WIDOWED
* COUNTY
* HOW LONG AT CURRENT ADDRESS * HOMEOWNER?
* MONTHLY RENT/MORTGAGE PAYMENT
* HOW LONG AT CURRENT ADDRESS * HOMEOWNER?
* MONTHLY RENT/MORTGAGE PAYMENT
YRS
MON
YRS
MON
IF CURRENT ADDRESS LESS THAN 2 YEARS, PLEASE PROVIDE PREVIOUS ADDRESS
IF CURRENT ADDRESS LESS THAN 2 YEARS, PLEASE PROVIDE PREVIOUS ADDRESS
* HOME PHONE
* CELL PHONE
*WORK PHONE
* HOME PHONE
* CELL PHONE
*WORK PHONE
EMAIL ADDRESS
EMAIL ADDRESS
* COMMERCIAL DRIVERS LICENSE # * DATE ISSUED
* STATE CDL ISSUED IN
* COMMERCIAL DRIVERS LICENSE # * DATE ISSUED
* STATE CDL ISSUED IN
* TRUCK DRIVING EXPERIENCE
OWNER/OPERATOR EXPERIENCE (IF APPLICABLE)
* TRUCK DRIVING EXPERIENCE
OWNER/OPERATOR EXPERIENCE (IF APPLICABLE)
YRS
MON
YRS
* RELATIONSHIP?
MON
YRS
* LENDER NAME
MON
YRS
* EQUIPMENT DESCRIPTION * EQUIPMENT DESCRIPTION * EQUIPMENT DESCRIPTION * EQUIPMENT DESCRIPTION * EQUIPMENT DESCRIPTION * EQUIPMENT DESCRIPTION
MON
* AMOUNT OWED * AMOUNT OWED * AMOUNT OWED * AMOUNT OWED * AMOUNT OWED * AMOUNT OWED
* NAME OF NEAREST RELATIVE NOT LIVING WITH YOU
Current & Paid Credit Information:
* LENDER NAME
*NEAREST RELATIVE STREET, CITY, STATE, ZIP
* NEAREST RELATIVE PHONE NUMBER
HAVE YOU EVER FILED FOR BANKRUPTCY? ARE YOU A DEFENDANT IN ANY LEGAL ACTION? ANY TAX LIENS/JUDGEMENTS AGAINST YOU? HAVE YOU HAD ANY ITEM(S) REPOSSESSED?
YES YES YES YES
NO NO NO NO
* LENDER NAME * LENDER NAME * LENDER NAME * LENDER NAME
* IF YOU ANSWERED YES ABOVE, PLEASE EXPLAIN BELOW. ATTACH ADDITIONAL SHEETS AS NEEDED.
This Purchase will haul for:
APPLICANT TO DRIVE THIS PURCHASE? APPLICANT 1ST TIME OWNER/OPERATOR? FIRST TRUCK/TRAILER PURCHASE?
YES YES YES NO NO NO
* COMPANY NAME * ICC NUMBER * CONTACT NAME * COMPANY STREET. CITY, STATE, ZIP CODE * PHONE NUMBER
Employment Information:
* EMPLOYER NAME * EMPLOYER NAME * EMPLOYER NAME * EMPLOYER NAME * EMPLOYER NAME * CONTACT NAME * CONTACT NAME * CONTACT NAME * CONTACT NAME * CONTACT NAME * PHONE NUMBER * PHONE NUMBER * PHONE NUMBER * PHONE NUMBER * PHONE NUMBER * HOW LONG? YRS * HOW LONG? YRS * HOW LONG? YRS * HOW LONG? YRS * HOW LONG? YRS
Last Years Income:
* LAST YEARS GROSS INCOME * LAST YEARS TOTAL EXPENSES * PROFIT / LOSS
$0
MY ESTIMATED NET MONTHLY INCOME FOR NEXT YEAR IS:
Personal Net Worth Statement: Assets: Liabilities:
CASH CHECKING ALL SAVINGS IRA/401K/SEP/ETC REAL ESTATE ACCTS RECEIVABLE AUTOMOBILES PERSONAL PROPERTY INSURANCE POLICIES ALL OTHER ASSETS CREDIT CARDS CHARGE ACCOUNTS BANK LOANS LEASES-AUTO AND OTHER MORTGAGE(S) ALIMONY/CHILD SUPPORT ALL OTHER LIABILITIES
For the purpose of establishing and maintaining credit, the undersigned submits the foregoing 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 you immediately in writing of any materially unfavorable change in my financial condition of the above matters, and in the absence of such notice or of a new and full written statement, all matters herein may be considered as a continuing statement and substantially correct. The undersigned hereby authorizes Shelby Elliotts Used Trucks, Inc. and any financial or lending institution or broker thereof, to make inquiry into, to request, and to receive any information concerning any character, general reputation, personal characteristics, mode of living, and all information from creditors which Shelby Elliotts Used Trucks, Inc. or any financial or lending institution or broker thereof, 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 is extinguished automatically upon full payment of the present borrowing, if any granted. Upon my written request, additional information as to the scope of this inquiry, if one is made, will be provided. The undersigned authorizes Shelby Elliotts Used Trucks, Inc. and any financial or lending institution, or broker thereof, they may use to obtain credit for the undersigned, as may be required concerning the statements contained in this application. The undersigned agrees that this application and supplemental paperwork will remain the property of Shelby Elliotts Used Trucks, Inc. and any financial institution or broker thereof that was used to obtain credit for the undersigned.
Applicant Signature: Co-Applicant Signature:
Date: Date:
9/21/2012 9/21/2012
TOTAL ASSETS:
$0
TOTAL LIABILITIES: TOTAL NET WORTH:
$0
$0
FACTS Why? What?
WHAT DOES SHELBY ELLIOTT'S USED TRUCKS INC DO WITH YOUR PERSONAL INFORMATION? Financial companies choose how they share your personal information. Federal law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do. The types of personal information we collect and share depend on the product or service you have with us. This information can include: Social Security number and income sources Payment and Credit History Credit Scores and Empolyment information
How?
All financial companies need to share customers personal information to run their everyday business. In the section below, we list the reasons financial companies can share their customers personal information; the reasons Shelby Elliott's Used Trucks Inc chooses to share; and whether you can limit this sharing.
Does Shelby Elliott's Used Trucks Inc share?
Reasons we can share your personal information
For our everyday business purposes
such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus.
Can you limit this sharing? NO
YES
For our marketing purposes YES NO to offer our products and services to you For joint marketing with other financial companies NO NO For our affiliates everyday business purposes NO NO information about your transactions and experiences For our affiliates everyday business purposes NO YES information about your creditworthiness For our affiliates to market to you NO YES For our nonaffiliates to market to you NO YES Call (573) 471-2100 to contact our opt out department To limit finance@shelbyelliott.com our sharing Visit us online at www.shelbyelliott.com or email shelbyeut@aol.com Mail the form below Please note:
If you are a new customer, we can begin sharing your information [30] days from the date we sent this notice. When you are no longer our customer, we continue to share your information as described in this notice. However, you can contact us at any time to limit our sharing.
finance@shelbyelliott.com Questions? Call (573) 471-2100 or email us at shelbyeut@aol.com ___________________________________________________________________________________ Mail-in Form (Cut at above line)
Mark any/all you want to limit: ___ Do not share information about my creditworthiness with your affiliates for their everyday business purposes. ___ Do not allow your affiliates to use my personal information to market to me. ___ Do not share my personal information with nonaffiliates to market their products and services to me.
Name Street
City, State, Zip Account Number (if applicable)
Mail:
Shelby Elliott's Used Trucks Inc 475 Western Dr Sikeston, MO 63801
Who we are Shelby Elliott's Used Trucks Inc is providing this notice What we do How does Shelby Elliott's Used Trucks Inc protect my personal information? How does Shelby Elliott's Used Trucks collect my personal information?
To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings. We collect your personal information, for example, when you Fill out, sign and submit a credit application to Shelby Elliott's Used Trucks We also collect your personal information from others, such as credit bureaus, affiliates, employers or other companies.
Federal law gives you the right to limit only: sharing for affiliates everyday business purposesinformation about your creditworthiness affiliates from using your information to market to you sharing for nonaffiliates to market to you State laws and individual companies may give you additional rights to limit sharing. More info http://epic.org/privacy/fcra/RS21427.pdf
Why cant I limit all sharing?
What happens when I limit sharing for an account I hold jointly with someone else?
Your choices will apply to everyone on your accountunless you tell us otherwise.
Definitions Affiliates
Companies related by common ownership or control. They can be financial and nonfinancial companies.
Nonaffiliates
Companies not related by common ownership or control. They can be financial and nonfinancial companies.
Joint marketing
A formal agreement between nonaffiliated financial companies that together market financial products or services to you.
Other important information More more information on your rights as a consumer go to http://www.ftc.gov/privacy/
