United Trailer Leasing Credit Application

General Information
Company Name/ Individual/ Trade Name/ DBA: Federal Tax ID #: Sales Tax Exempt #: USDOT #  * Fields in Red are required fields.
Street Address: City: State: Zip Code:
Billing Address: City: State: Zip Code:
 
Phone: Fax: Date Established:  
   
Company Organization Type: Business/Industry Type: Accounts Payable Contact Name:  Accounts Payable Email: 
   
Units in Fleet:    
# of Tractors # of Trucks  # of Trailers   
Any Repositions: Any Bankruptcies Fillings: Financial Statements Available:  
 
full name of owner(s) (or authorized officer of corportation), list home address and zip code for partnership or individual
First Name:  Last Name: Title: Social Security #:
City: State: Zip:
First Name: Last Name: Title: Social Security #:
City: State: Zip:

Insurance Information
Insurance Company: Phone #: Policy #:
City: State: Zip:

Employment
Employer Name (complete): Phone #: Contact:
City: State: Zip:

Credit References
Complete Name: Contact Person: Account #: City: State: Phone #:
Complete Name: Contact Person: Account #: City: State: Phone #:
Complete Name: Contact Person: Account #: City: State: Phone #:
Complete Name: Contact Person: Account #: City: State: Phone #:
Complete Name: Contact Person: Account #: City: State: Phone #:

Bank References
Name of Bank: Loan Officer: Checking Account #: City: State: Phone #:
Name of Bank: Loan Officer: Checking Account #: City: State: Phone #: