Dealer Application Dealer Application What would you like to finance* Personal Information Name* Address City, State, & Zip Social Security Number* -- Date of Birth 123456789101112 / 12345678910111213141516171819202122232425262728293031 / 2024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200120012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Phone Number - - Email Address 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 123456789101112 / 12345678910111213141516171819202122232425262728293031 / 2024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200120012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 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: 12345678910111213141516171819202122232425 Years as Owner-Operator: 12345678910111213141516171819202122232425 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/Phone Number: - - Cost of Equipment Points Requested (0-4 points) 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. I read and understand the terms and conditions and verify that all information provided is truthful and accurate to the best of my knowledge. Holt Truck Finance P.O. Box 476 Sylvania, OH 43560 Phone: 419-214-4502 Fax: 419-720-3980 Email: info@holtfinance.com
