Financing Application
Peterbilt Financial Credit Application
PERSONAL INFORMATION
 
Today's Date 
Full Name 
Birth Date 
S.S. Number 
Marital Status 
Single Married Separated Widowed Divorced
Dependents 
Address 
City-State-ZIP 
Phone Number 
How Long at  Address?  Yrs.
How Long in  Area?  Yrs.
Former 
Addresses 
(5 Yrs.) 
Business Name 
Business  Address 
Tax I.D. Number 
Business Phone 
 
EMPLOYMENT HISTORY INFORMATION
 
Present and Past Employment for Five Years (Present or Last Employer First)
Company 
Address 
City-State-ZIP 
Phone Number 
Position Held 
How long?  Years & Months
 
Former Company 
Address 
City-State-ZIP 
Phone Number 
Position Held 
How long?  Years & Months
 
Former Company 
Address 
City-State-ZIP 
Phone Number 
Position Held 
How long?  Years & Months

Complete this section only if this is a joint application with your spouse, or if you are relying on your spouse's income or assets as a basis for repayment of the credit requested, or if you reside in community property state.
Spouse's Full Name 
Date of Birth 
S.S. Number 
Spouse's Employer 
Position Held 
How Long?  Years & Months
 
Nearest relatives not living with you:

Self
Full Name 
Address 
Relationship 

Spouse
Full Name 
Address 
Relationship 
 
Have You Ever Taken Bankruptcy?  No Yes - Explain Below
 
Are You a Defendant In Any Legal Action?  No Yes - Explain Below
 
Have You Ever Had Any Item Repossessed?  No Yes - Explain Below
 
Explanation: 
 
TRUCK USAGE
 
How Long As Owner/Operator?  Years & Months
Operator License Number 
License State 
License Date 
 
Purchaser To Drive?  Yes No-Provide Information Below On Person Who Will Drive Truck.
 
Driver's Name 
Address 
Years Experience 
Operator License Number 
License State 
License Date 
Driver S.S. Number 

Truck To Work For:
Company 
Address 
If Trucking - Between What Points 
Off-Highway Use?  Yes No
Average Mileage Per Month 
 
FIRE, THEFT, CAC AND COLLISION INSURANCE IS REQUIRED
 
Name of Agent 
Address 
Phone Number 
Name of Company 
Address 
Coverage to be Subject to Mileage Restriction?  Yes No
 
BALANCE SHEET
 
Assets (What you own)
Cash on Hand & in Banks 
Accounts Receivable 
Vehicles Owned 
Real Estate 
Other Assets 
Total Assets 
Liabilities (What you owe)
Accounts Payable 
Loans on Vehicles 
Mortgages on Real Estate 
Other Debts 
Total Liabilities 
Net Worth 
Total Liabilities & Net Worth 
 
INCOME STATEMENT
 
Time Period
From 
To 
 
Gross Trucking Income 
+ 
  
Other Income 
- 
  
Deductions & Expenses 
= 
  
Operating Profit 
 
CREDIT REFERENCES
 
List credit references on Paid Accounts
Name 
City-State 
Phone Number 
Contact Person 
Account No. 
Highest Owing 
 
Name 
City-State 
Phone Number 
Contact Person 
Account No. 
Highest Owing 
 
Name 
City-State 
Phone Number 
Contact Person 
Account No. 
Highest Owing 
 
Bank Reference Name 
City-State 
Account Number 
 
SIGN AND DATE
 
For the purpose of establishing credit, the undersigned submits the foregoing statement and information contained above, 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 or the above matters, and in the absence of such notice or of a new and full written statement, all mattter herein may be considered as a continuing statement and substantially correct. The undersigned hereby authorizes PFC to make inquiry into, to request, and to receive any information concerning my character, general reputation, personal characteristics, mode of living, and all information from creditors which PFC 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 extinguised automatically upon full payment of the present borrowing, if any is granted. Upon my written request, additional information as to the scope of this inquiry, if one is made, will be provided.

I further represent that neither the undersigned, any principal officer of the undersigned, nor any contemplated operator of any equipment proposed to be purchased has any record or reputation of having violated any federal or state laws relating to liquor, narcotics or contraband; and no such person has been convicted of any felony.

I understand that PACCAR Financial Corp., and/or Seller of motor vehicle, parts or services to whom this application is presented, will be relying on the accuracy of the matters set forth herein as a basis for extending any credit which I may receive.
Signature
 Date
Signature
 Date
Email Address   

Disclaimer: E-mail is not considered to be a completely secure medium for the transmission of sensitive information. Those who email credit application information do so at their own risk.

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11 Industrial Lane Johnston, RI 02919
Phone: 401.351.0900
Email: info@peterbiltofri.com