Long Application – GEM TRUCK FINANCING

Seller/ Dealer Name *
Dealer Phone *
Dealer Fax
Dealer Address
Cost of Truck *
$5,000 - $9,999$10,000 - $19,999$20,000 - $29,999$30,000 - $39,999$40,000 - $49,999$50,000 - $59,999$60,000 - $99,999***

Your Company Name: (as filed with the State) *
Company Registered Address: (as filed with the State) *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Company Physical Address (if different from Registered Address)
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Company Phone
Years in business
Buisness Type
Feberal ID #
D.O.T #
Motor Carrier #
CAB Card #
Will you have additional Drivers? *
YES?NO?
Additional Driver License #
Add. Driver Lic State

Co-Borrower *
YES?NO?
Co-Borrower Full Name
D.O.B
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone
Email
Social Security #

How long at current Loaction *(include both Months and Years)
Do you Rent or Own your Home? *
OwnRentOther
Explain Other:
Mortgage/ Landlord Name *
Mortgage/ Landlord Phone *
Mortgage/ Landlord Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Mortgage Account Number
Value of Home (YTD) *
Mortgage Ballance (YTD) *
Have you ever been listed in Bankruptcy Proceedings; (either Business or Personal) *
YESNO
Explain:

Branch Name (Account #1)
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Account #
Account Type
CheckingSavingCredit Union
Branch Name (Account #2) ACCOUNT #2
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Account #
Account Type
CheckingSavingCredit Union

Current Employer Name *
Address *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone *
Job Title/ Division
Annual Income *
Supervisor Name *
How Long at Job *

Future Employer Name
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone
Expected Annual Income

Previous Employer
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone
How Long Employed

Will this be your: *
FirstAdditionalReplacement Unit
How Many People Do You Cuurently Employ?
What type of Product(s) do you Haul?
Whats the Radius you Haul?
LOCAL (not more than 50 miles)INTERMEDIATE (between 50 and 200 miles)LONG DISTANCE (more than 200 miles).

Full Name
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone
Email
Relation?

Full Name
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone
Email
Relation?

Full Name
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone
Email
How is Non-Relative known: