Credit Application

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    Credit Application

    Customer Information

    Customer Name:

    Email

    Phone #

    TIN or SS# (If Individual/DBA): Required:

    Billing Address:

    City

    State

    Zip code

    Physical Address (If different):

    City

    State

    Zip code

    Contact/Title:

    Fax:

    County:

    Type of Entity (If business):
    C-CorporationS-CorporationLimited Liability Company/Corporation

    State of Incorporation:

    Year Incorporated

    Homeowner (If Individual):
    YesNo

    Date of Birth (If Individual):

    COMPANY OWNER INFORMATION (IF APPLICABLE)

    Owner # 1/Parent Company Name and Address (If different than above):

    TIN or SS# (If Individual/DBA) Required:

    Address:

    City

    State

    Zip code

    % Ownership:

    Contact/Title:

    Date of Birth:

    Phone #:

    Fax:

    Owner # 2/Parent Company Name and Address (If different than above):

    TIN or SS# (If Individual/DBA) Required:

    Address:

    City

    State

    Zip code

    % Ownership:

    Contact/Title:

    Date of Birth:

    Phone #:

    Fax:

    BANK INFORMATION

    Bank Name/Branch:

    Account #:

    Contact/Title:

    Phone #:

    Fax:

    TRADE REFERENCES

    Trade Name # 1:

    Contact/Title:

    Phone #

    Fax #:

    Trade Name # 2:

    Contact/Title:

    Phone #

    Fax #:

    Trade Name # 3:

    Contact/Title:

    Phone #

    Fax #:

    TRUCKING EXPERIENCE

    Number of Years Driving Experience:

    Number of Years as an Owner Operator:

    Haul Source(s):
    Current

    1)

    Phone #:

    Contact:

    How Long:

    2)

    Phone #:

    Contact:

    How Long:

    3)

    Phone #:

    Contact:

    How Long:

    Previous

    1)

    Phone #:

    Contact:

    How Long:

    2)

    Phone #:

    Contact:

    How Long:

    3)

    Phone #:

    Contact:

    How Long:

    FLEET INFORMATION

    Number of TRUCKS Owned:

    Number of TRAILERS Owned:

    EQUIPMENT FINANCE CREDIT (WHO FINANCED PREVIOUS EQUIPMENT PURCHASES)

    Current
    1)

    Equipment (Year/Make/Model):

    Finance Company/Bank:

    Contact Name:

    Phone #:

    Account #:

    2)

    Equipment (Year/Make/Model):

    Finance Company/Bank:

    Contact Name:

    Phone #:

    Account #:

    3)

    Equipment (Year/Make/Model):

    Finance Company/Bank:

    Contact Name:

    Phone #:

    Account #:

    EQUIPMENT FINANCE CREDIT (WHO FINANCED PREVIOUS EQUIPMENT PURCHASES)

    Previous
    1)

    Equipment (Year/Make/Model):

    Finance Company/Bank:

    Contact Name:

    Phone #:

    Account #:

    2)

    Equipment (Year/Make/Model):

    Finance Company/Bank:

    Contact Name:

    Phone #:

    Account #:

    3)

    Equipment (Year/Make/Model):

    Finance Company/Bank:

    Contact Name:

    Phone #:

    Account #:

    LEGAL ACTIONS

    Prior Bankruptcy:
    YesNo

    Ever Have a Repossession:
    YesNo

    Any Unpaid Judgments:
    YesNo

    ** PROVIDE EXPLANATION FOR ANY YES ANSWERS ON THE FOLLOWING TEXTAREA **

    EXPLANATION


    The information given above is true and complete. Atlantic Utility Trailer Sales, Inc. may receive from and disclose to other persons, including credit reporting agencies information about Applicant and/or Business Owner’s account and credit experience and Applicant and/or Business Owner authorizes any person to release to Atlantic Utility Trailer Sales, Inc. credit experience on Applicant and/or Business Owner made by Atlantic Utility Trailer Sales, Inc., or any person requested to release such information. Atlantic Utility may also assign these rights to any of their credit partners for the purpose of their credit investigation and applicant authorizes the release of any information to these assignees.


    In consideration of being allowed the privilege of an open credit account, the undersigned, an authorized representative for the above named company applying for credit, hereby agrees to abide by the terms and conditions of the Atlantic Utility Trailer Sales, Inc.’s rental agreements, including but not limited to Atlantic Utility Trailer Sales, Inc.’s payment terms:

    PAYMENT DUE UPON RECEIPT OR UPON TERMS OF AGREEMENT.


    In case of default in payments, Atlantic Utility Trailer Sales, Inc. shall be entitled to exercise remedies, in addition to all other rights permitted by law:

    • To assess late fees and/or interest

    • To submit the debt to a collection agency

    • To submit the debt to all major credit bureaus

    • The Customer agrees to pay all costs of collection, including reasonable attorney’s fees


    This agreement shall be governed by the laws of the State of New Jersey.