Tarp Systems Financing Application Tarp Systems Personal Information Name* Address City, State, & Zip Social Security Number* Date of Birth 123456789101112 / 12345678910111213141516171819202122232425262728293031 / 20192018201720162015201420132012201120102009200820072006200520042003200120012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Contact Number Email Address Home Owner? YesNo Have you had any repossessions in the past 8 years? YesNo Company Information Company Name Date Formed 123456789101112 / 12345678910111213141516171819202122232425262728293031 / 20192018201720162015201420132012201120102009200820072006200520042003200120012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Annual Revenue Number of Employees Number of Trucks Owned Number of Trailers Owned Does your trailer have a lien? YesNo If yes, how much? Trucking Industry Experience Hauling Reference Company Name Hauling Reference Contact Number Contact Name: Equipment-Vendor Information What do you Haul? Have you picked out the equipment you want to finance? YesNo Equipment Description: Cost of Equipment Salesperson Name: Electronic Signature * By typing your full name 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 First Rate Transportation Finance, LLC, 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 result 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. *Must be a resident of Ohio, Michigan, Indiana, Kentucky, West Virginia or Western Pennsylvania Holt Truck Finance 7644 Kings Pointe Rd Toledo, OH 43617 Phone: 419-214-4502 Fax: 419-720-3980 Email: info@holtfinance.com
