BUSCENTRAL.COM

 

 

 211 Babb Dr
P.O. Box 1299
Lebanon, TN 37087

 

 

        PH: 615-444-2874
FX: 615-444-0780

 

 

 

 

CREDIT APPLICATION

 

B

U

LEGAL BUSINESS NAME

 

TELEPHONE

FAX

S

I

ADDRESS (STREET)

 

(CITY)

 

(STATE)

 

(COUNTY)

 

(ZIP CODE)

 

N

E

TYPE OF BUSINESS

 

US DOT NO.

MC / MX NO.

AGE OF BUSINESS

 

FED. TAX NO.

 

S

S

 

LOCATION OF EQUIPMENT (STREET)

 

(CITY)

 

(STATE)

 

(COUNTY)

 

(ZIP CODE)

 

 

O

W

N

Business Structure

Proprietorship Partnership C-Corporation S-Corporation LLC LLP DBA

PRINCIPALS NAME

TITLE

 

% OWNERSHIP

 

HOME PHONE NO.

 

SOC. SEC. NO.

 

E

R

HOME ADDRESS (STREET)

(CITY)

 

(STATE)

 

(ZIP CODE)

 

OWN

RENT

DRIVERS LIC. NO.

S

H

PRINCIPALS NAME

TITLE

 

% OWNERSHIP

 

HOME PHONE NO.

 

SOC. SEC. NO.

 

I

P

HOME ADDRESS (STREET)

(CITY)

 

(STATE)

 

(ZIP CODE)

 

OWN

RENT

DRIVERS LIC. NO.

 

B

A

N

K

S

 

BANK

 

BRANCH

 

 

TELEPHONE

 

FAX

 

ACCOUNT UNDER NAME OF

 

CHECKING ACCT. NO.

 

CURRENT BALANCE

 

CONTACT PERSON

 

BANK

 

BRANCH

 

 

TELEPHONE

 

FAX

 

I

N

S

ACCOUNT UNDER NAME OF

 

CHECKING ACCT. NO.

 

CURRENT BALANCE

 

CONTACT PERSON

 

 

FINANCE COMPANY

ACCOUNT NO.

TELEPHONE NO.

CONTACT PERSON

T

R

 

 

 

 

 

 

 

 

A

D

 

 

 

 

 

 

 

 

E

S

 

 

 

 

 

 

 

 

 

CURRENT FLEET DATA (ATTACH ADDITIONAL LIST IF NEEDED)

YEAR

MAKE

MODEL

OWNED

LEASE

LIENHOLDER

 

 

 

 

 

 

 

 

 

 

 

 

INSURANCE INFORMATION

COMPANY NAME

AGENT NAME

PHONE (INCLUDE AREA CODE)

REASON FOR ADDITIONAL OR REPLACEMENT COACH (ES) (EG: contract, new business, etc.)

EXPLAIN:

 

INFORMATION TO INCLUDE WITH APPLICATION:

( ) 3 YEARS CORPORATE TAX RETURNS AND FINANCIAL STATEMENTS ( ) 3 YEARS PERSONAL TAX RETURNS ( ) PERSONAL FINANCIAL STATEMENT

DO YOU OWN A SECURE LOT OR GARAGE?

YES

NO

ANY OUTSTANDING TAX LIENS, SUITS OR JUDGEMENTS?

YES

NO

DO YOU HAVE A MECHANIC ON THE PREMISES?

YES

NO

HAVE YOU EVER FILED BANKRUPTCY?

YES

NO

WILL THE COACH(ES) EVER BE SUB-LEASED?

YES

NO

HAVE YOU EVER HAD VEHICLES OR EQUIPMENT REPOSSESED?

YES

NO

 

I hereby authorize BUSCENTRAL.COM or any credit bureau or other investigative agency employed by BUSCENTRAL.COM to investigate the references herein listed or statements or other data obtained from me or from any other person pertaining to my credit and financial responsibility.

 

X_______________________________________

SIGNATURE / TITLE

 

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DATE