PRE-QUALIFICATION APPLICATION

General Information

 

 

 

 

Years Months

 

Vehicle and Warranty Information

 

 

 

 

MAJOR REPAIR HISTORY

For each component that has been repaired, please indicate how long ago the work was performed and the severity of the repair.
 
Component
1) Aftertreatment System/Emissions System
2) Turbocharger
3) Injectors
4) Head Gasket
5) Engine
6) Clutch
7) Transmission
8) APU Unit
 

Main Operating Bank Account

 

 
 

Signature

 
I hereby acknowledge that I am over the age of eighteen (18) years, and that all information set forth in this credit application is true, accurate, and a full and complete disclosure thereof. I authorize Trucksuite, LLC - ERM, its Representative, Agent, or Assignee to gather whatever credit information is deemed necessary for approval and to provide such information to financial institutions or others in connection with this credit request, and I understand this application will be retained whether or not it is approved. I further acknowledge and agree I will notify the creditor or prospective creditor, in writing, of any change in my name, address, or employment within a reasonable time thereafter. Any false, erroneous, and/or misleading information provided in this Credit Application or Enrollment/Installment Agreement will be cause for immediate cancellation of any financing arrangements and/or termination of my enrollment.