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1 (800) 676-1694
Home
About
Services
All Services
Reefer Trailer Leasing
Dry Van Trailer Leasing
Credit Application
Contact Us
Menu
Home
About
Services
All Services
Reefer Trailer Leasing
Dry Van Trailer Leasing
Credit Application
Contact Us
SECURE BUSINESS CREDIT APPLICATION
COMPANY INFORMATION
"
*
" indicates required fields
Legal Business Name:
*
MC#
*
Federal Tax ID#
*
Main Phone Number
*
Email Address
*
Company Street Address
*
City
*
City
State
*
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
*
ZIP Code
Type of Business / Industry:
In Business Since
Legal Form Under Which Business Operates:
C corporation
S corporation
LLC
DBA
Partnership
Proprietorship
If Division or Subsidiary, Name of Parent Company:
In Business Since:
Source
*
None
Mailchimp
Google
Outside Sales
Facebook
Linked in
D&B
Fuel Card Dept
Driver Referral
Sales Team
*
None
Jorge Martinez
Dave Espinoza
Andres Calderon
DESIRED EQUIPMENT
Equipment Type Needed:
*
Type of Trailer
Dry Van Trailers
Reefer Trailers
Both
Quantity Needed
Desired Term
*
Term Length
1 Year
2 Years
GPS?
Yes
No
Notes / Specific Equipment Requests:
APPLICANT / REPRESENTATIVE INFORMATION:
PRIMARY COMPANY PRINCIPAL RESPONSIBLE FOR BUSINESS TRANSACTIONS:
First Name
*
First
Middle Name
First
Last Name
*
First
Date of Birth
MM slash DD slash YYYY
Title
*
Social #
*
Office Phone Number
Mobile Phone Number
*
Email Address
*
Street Address
*
Street Address
City
*
City
State
*
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
*
ZIP Code
ADDITIONAL COMPANY PRINCIPAL RESPONSIBLE FOR BUSINESS TRANSACTIONS
First Name
First
Middle Name
First
Last Name
First
Date of Birth
MM slash DD slash YYYY
Title
Social #
Office Phone Number
Mobile Phone Number
Email Address
Street Address
Street Address
City
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
ZIP Code
TRADE REFERENCES
Company Name:
*
First
Contact Person:
*
First
Phone Number
*
Street Address:
*
Street Address
City
*
City
State
*
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
*
ZIP / Postal Code
TRADE REFERENCES 2
Company Name:
*
First
Contact Person:
*
First
Phone Number
*
Street Address:
*
Street Address
City
*
City
State
*
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Zip Code
*
ZIP / Postal Code
CREDIT HISTORY
Have you, your company officers or affiliates, or your company ever filed a petition in bankruptcy?
*
Yes
No
Are you, your company officers or affiliates, or your company subject to any litigation?
*
Yes
No
If you answered yes to either of the above or have items negatively affecting your credit history which require explanation please provide that information here:
DRIVER’S LICENSE
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Acknowledgement
I/We certify that all information entered in this application is true and complete. This request is for an AI Trailer Lease Inc billing account. I/We authorize AI Trailer Lease to obtain further information concerning the credit and financial condition of the corporation, principal owner, proprietors, or partners; and to exchange or provide information with other credit grantors.
Signature
*
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SIGNATURE
Comments
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