General Information First Name Last Name *Street *City *State/Province —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon *Zip *Country —Please choose an option—United StatesCanada *Social Security # / Social Insurance # *Citizenship —Please choose an option—U.S. citizenCanadian CitizenPermanent resident alienTemporary resident alienNon-resident alien *Date of Birth *Email *Phone *CDL Number *CDL State/Province —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundlandNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon *How long have you had your CDL? —Please choose an option—NoneLess than 1 year1-2 years3-5 years6-10 years10+ years Business Name (if applicable) Business Email Business Phone Please indicate whether you have experienced any of the following: Repossesion/Voluntary SurrenderBankruptcyForeclosureDeliquent Tax Loan, Family Support or Student Loans If you have experienced a bankruptcy, what date was it discharged/dismissed *Monthly Income Is your Credit Score Higher than 650? YesNoNot Sure If necessary, do you have someone who can serve as a Cosigner? YesNo Truck Information *Year *Make *Model *Condition —Please choose an option—ExcellentVery GoodGoodFairPoor *Odometer Reading *VIN Financing Type Requested Are you interested in Repair Financing? —Please choose an option—YesNo Repair Facility Name Contact Name Contact Phone Contact Email Repair Estimate Repair Description Last Oil & Filter Change Date Last Oil & Filter Change ODO Other PM Services Performed: For each component that has been repaired, please indicate how long ago the work was performed and the severity of the repair. Component Last Repaired (Mo) Work Performed Aftertreatment System/Emissions System —Please choose an option—No61218243648 —Please choose an option—RepairedReplacedRebuildPartial Rebuild Turbocharger —Please choose an option—No61218243648 —Please choose an option—RepairedReplacedRebuildPartial Rebuild Injectors —Please choose an option—No61218243648 —Please choose an option—RepairedReplacedRebuildPartial Rebuild Head gasket —Please choose an option—No61218243648 —Please choose an option—RepairedReplacedRebuildPartial Rebuild Engine —Please choose an option—No61218243648 —Please choose an option—RepairedReplacedRebuildPartial Rebuild Clutch —Please choose an option—No61218243648 —Please choose an option—RepairedReplacedRebuildPartial Rebuild Are you interested in Warranty Financing? —Please choose an option—YesNo Warranty Coverage Term —Please choose an option—30 days60 days90 days12 months24 months36 months48 months Warranty Options Transmission & DifferentialHVACAPURefrigeration By clicking submit, I am acknowledging that I am over the age of eighteen (18) years old, and that all information contained in this credit application is accurate. I am authorizing TruckSuite LLC, its representatives, affiliates and assigns to gather any credit related information as may be necessary to process and evaluate an extension of credit to me, including obtaining a consumer and/or business credit report relative to me personally or my business, and provide such information to financial institutions or others in connection with this credit request. I understand this application will be retained whether or not it is approved.
