United Truck Group Credit Application Form
* indicates a required field.
Personal Information
First Name
*
Middle Initial
Last Name
*
Street Address
*
City
*
State
*
ZIP Code
*
Email address
*
Primary Phone
*
Alternate Phone
Social Security Number
*
Can you provide proof of U.S. Citizenship?
*
Yes
No
Date of Birth
*
(ex. 01/31/1965)
If married, enter spouse's name
If you have previously spoken with a United Truck Group salesman before, enter name
Residency Information
Home Ownership
Own
Rent
Monthly rent or mortgage
$
If at current address less than 2 years, list previous address
Driver History
Check box if applicant is not driver and enter driver information in the Other Driver Information box below.
Drivers License #
State issuing license
Number of years driving trucks
If your truck will be leased to a
haul company
Haul Company Name
Primary Phone
Contact Person
If you run under your
own authority
Your business name
MC or DOT #
Other Driver Information
If anyone other than you will drive the truck, complete the following
Driver Name
Driver Address
Cell Phone
Driver Date of Birth
(ex. 01/31/1965)
Driver License #
State issuing license
Years driving a Truck
Financial History
Have you ever declared bankruptcy?
*
Yes
No
If so, explain circumstances and date
Have you ever had anything repossessed?
*
Yes
No
If so, explain circumstances and date
Employment History - List most recent first
Company Name
*
Phone Number
Contact Person
*
Length of Employment
*
Company Name
Phone Number
Contact Person
Length of Employment
List Ten verifiable, complete references
Name
*
Address
*
Primary Phone
*
Cellphone
Relationship
*
(ex. brother, friend)
Name
*
Address
*
Primary Phone
*
Cellphone
Relationship
*
Name
*
Address
*
Primary Phone
*
Cellphone
Relationship
*
Name
*
Address
*
Primary Phone
*
Alternate Phone
Relationship
*
Name
*
Address
*
Primary Phone
*
Alternate Phone
Relationship
*
Name
*
Address
*
Primary Phone
*
Alternate Phone
Relationship
*
Name
*
Address
*
Primary Phone
*
Alternate Phone
Relationship
*
Name
*
Address
*
Primary Phone
*
Alternate Phone
Relationship
*
Name
*
Address
*
Primary Phone
*
Alternate Phone
Relationship
*
Name
*
Address
*
Primary Phone
*
Alternate Phone
Relationship
*
By submitting this application, I authorize United Truck Group, LLC and its affiliates to review my credit information. I understand United Truck Group, LLC will check my credit and review its contents. I also give United Truck Group, LLC and its affiliates permission to obtain my Motor Vehicle Report (MVR) and review its contents.
Check here to agree to the above terms and conditions