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Sternberg Chrysler Dodge Automotive Dealer, International Trucks in Indiana, Kentucky, Illinois Tri-State
Sternberg Chrysler Dodge Automotive Dealer, International Trucks in Indiana, Kentucky, Illinois Tri-State

Commercial Truck Credit Application

Be assured that the information you submit is kept secure and confidential.
* In order to process a quick response please input data in all fields that apply

Business Information
Preferred Salesman:
Business Name:
 Proprietor Corporation Partnership LCC
Address:
City:
 State:
 Zip:
Business Phone:
 Business Fax:
Email:
Years in Business:
 Federal Tax ID Number:
 Dun & Bradstreet:
Type of Business:
 Primary use of Truck:
Do you have your own authority?
Yes No
US DOT Number:
Are you Tax Exempt?
Yes No
If so, Tax Exempt Number:
Start Up Replacement Additional Equipment Current Fleet Size:
Years of Driving Experience:
Driver:
 Owner Operator:
Applicant to Drive?
Yes No
If no, Driver's Name:
Driver's License Number:
 Expiration Date:
Owner Operation Contract with:
 Name of Contact
Years with Company:
 Phone Number for Contact:
 Yearly Income:
References
Trade Reference #1:
Name:
 Address:
 City:
 State:
 Phone:
Trade Reference #2:
Name:
 Address:
 City:
 State:
 Phone:
Previous Verificable Comparative Credit:
Name of Lender:
 Account Number:
 Phone:
 High Credit:
Applicant's Information
First Name:
 Middle:
 Last Name:
Address:
City:
 State:
 Zip:
Day Phone:
 Evening Phone:
 Cell Phone:
 Fax:
Social Security Number:
Date of Birth:
Month:
 Day:
 Year:
Time at current address:
Years:
 Months:
Please Check one of the following:
Own/ Buying home Leasing/ Renting Living with Relative or Friend
Name of Landlord or Mortgage Holder:
 Phone Number of Landlord or Mortgage Holder:
Reference #1 (relative not living with you)
Name:
 Relationship:
 Phone:
Reference #2 (relative not living with you)
Name:
 Relationship:
 Phone:
Co-Applicant's Information
First Name:
 Middle:
 Last Name:
Address:
City:
 State:
 Zip:
Day Phone:
 Evening Phone:
 Cell Phone:
 Fax:
Social Security Number:
Current Employer:
 Employer's Phone:
 Annual Income:
Driver's License Number:
 Expiration Date:
Years of Driving Experience:
Driver:
 Owner Operator:
Banking Information
Name of Bank:
 Bank Phone:
 Contact Person:
Please check all that apply:
Checking and Savings Checking Only Savings Only Other None
Outstanding Personal Loans:
Name of Bank:
 Amount Borrowed:
 Monthly Payment:
 Opened Closed
Name of Bank:
 Amount Borrowed:
 Monthly Payment:
 Opened Closed
Have you ever filed for bankruptcy?
Yes No
Type of bankruptcy?
Chapter 7 Chapter 13
Has the bankruptcy been discharged?
Yes No
If yes, date of discharge:
Fair Credit Reporting Act Disclosure
By submitting this application, I understand you will be checking with credit reporting agencies and that the information provided by me is complete and accurate to the best of my knowledge. I also understand I may request in writing within a reasonable time a full disclosure report. Though this application will be forwarded to available financial institutions, I understand this does not obligate me in any way to use their financing source(s).
Privacy Notice
In connection with your transaction we may obtain nonpublic personal information about you and that information is handled as stated in this notice.

1. We collect personal nonpublic information about you from the following sources:

• Information we receive from you on applications or other forms;
• Information about your transactions with us, our affiliates or others; and,
• Information we receive from a consumer reporting agency.

2. We may disclose all the information we collect, as described above, to companies that perform marketing services or other functions on our behalf or to other financial institutions with whom we have joint marketing agreements.

3. We may also disclose nonpublic personal information about you, as a consumer, customer or former customer, to non-affiliated third parties as permitted by law.

4. Further, we restrict access to your nonpublic personal information to only those employees who need to know that information to provide products or services to you. Employees cannot use your information for any other purpose. For your protection, we maintain physical, electronic and procedural safeguards that comply with federal regulations.
By clicking Submit you agree to the above statement and allow Sternberg, Inc. to check your credit. If you choose not please click Reset.
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