P.O. Box 476 Sylvania, OH 43560 419-214-4502 info@holtfinance.com

Finance Application

Finance Application 

    What would you like to finance*

    Personal Information

    Name*

    Address

    City, State, & Zip

    Social Security Number*

    --

    Date of Birth

     /  / 

    Phone Number

    - -

    Home Owner?

    YesNo

    Have you had any repossessions in the past 8 years?

    YesNo

    Have you filed for bankruptcy in the past 8 years?

    YesNo

    Company Information

    Company Name

    Tax ID/EIN

    Date Formed

     /  / 

    Annual Revenue

    Number of Employees

    Number of Trucks Owned

    Number of Trailers Owned

    Do you factor your invoices?

    YesNo

    Trucking Industry Experience

    Years as Driver:

    Years as Owner-Operator:

    CDL?

    YesNo

    Hauling Reference Name

    Hauling Company Phone Number

    - -

    Contact:

    What do you Haul?

    Equipment-Vendor Information

    Have you picked out the equipment you want to finance?

    YesNo

    Equipment Description:

    Dealership/Private Party Name:

    Salesperson:

    Dealership/Private Party Phone Number:

    - -

    Cost of Equipment

    Referred By

    Electronic Signature *

    By signing below, each undersigned individual(s), who is either a principal of the credit applicant listed below or a personal guarantor of its obligations, provides written instruction to Holt Holdings, LLC dba Holt Truck Finance, or its designee (and any assignee or potential assignee thereof) authorizing review of his or her personal credit file from a national credit bureau. Such authorization shall extend to obtaining a credit profile in considering the application of the credit applicant and subsequently for the purpose of update, renewal, or extension of such credit, and for reviewing or collecting the resulting account. A photo static or facsimile copy of this authorization shall be as valid as the original.

    Holt Truck Finance

    P.O. Box 476 Sylvania, OH 43560
    Phone: 419-214-4502
    Fax: 419-720-3980
    Email: info@holtfinance.com