J. Merle Jones & Sons International
Credit Application

APPLICATION TYPE

Partnership Proprietorship Nonprofit Org. Corporation

Corporation Tax ID Number, if applicable  

PERSONAL INFORMATION
Primary Applicant  
Full Name  
License #  
(With State + Expiration Date)
Date Of Birth   Age
SSN      No. Dependents
Business Phone  
Residence Phone  
Spouse  
Full Name  
Date Of Birth   Age
SSN  
Present Address  
Address  
City-State-Zip  
How long?   Years & Months
Own/Rent   Own Rent
Mortgage/Rent Paid To  
Former Address  
Address  
City-State-Zip  

CORPORATION INFORMATION

Corporation Name  
Incorporated in what state?  
Date Of Incorporation  
Date In Business  
Principal   Age
Principal Title   % Owned
Principal   Age
Principal Title   % Owned

NEAREST RELATIVES NOT AT ABOVE ADDRESS

Name Address City-State Phone Relation

EMPLOYMENT - PAST AND PRESENT - FIVE YEARS

Company Name  
Contact Name     Ph# 
Address  
Position    How long? 
Company Name  
Contact Name     Ph# 
Address  
Position    How long?
Company Name  
Contact Name     Ph#
Address  
Position    How long?
How long as an owner-operator?  
Nature Of Business  
(Materials, Between What Points,
Construction, Over-The-Road, Etc.)
Gross Monthly Income  

TRADE-IN DESCRIPTION

Year Make Model Body Style/Type
Engine Transmission Rears Serial Number
Sleeper Tractor Pkg. Other Info.
Title State Months In Loan Payment Amount Amount Still Owed

PURCHASER'S FINANCIAL AND CURRENT CREDIT STATEMENT

Examples: How To Fill Out This Section
Description Bank Phone # Acct # Asset
Value		 Payment
Amount		 Amount You Owe
Checking Acct First Bank 800-888-8888 123456789 4200    
Savings Acct First Bank 800-888-8888 123456789 2450    
Ford Bronco Loan Fifth Bank 313-333-3333 4567890 15000 525 7200
1993 Freightliner FL120 National Bank 616-666-6666 123-4568 21500 800 12500
Home Loan City Savings Bank 555-555-1212 595955 120000 925 91700
Visa First Mutual 800-111-2222 4415 3341   100 6200
Stock N/A N/A N/A 8000    
Include:
  • Assets - Real Estate, Savings Account, Trucks, Trailers, Autos, Loans
  • Liabilities - Credit Cards, Fuel Bill, Etc.
Description Bank Phone # Acct # Asset
Value		 Payment
Amount

Amount You Owe
Have you filed bankruptcy in the last 10 years? Yes No
Any items repossessed? Yes No

SIGN AND DATE

The information given above is true and complete. Lender may receive from and disclose to other persons, including credit reporting agencies, information about Applicant's accounts and credit experience and Applicant authorizes any person to release to Lender credit experience and account information on Applicant. This shall be a continuing authorization for all present and future disclosures of account information and credit experience on Applicant made by Lender or any person requested to release such information to Lender.
Today's Date:
 Signed By:


Your E-Mail Address
 Your Title:

"Disclaimer: E-mail is not considered to be a completely secure medium for the transmission of sensitive information. Those who e-mail credit application information do so at their own risk."



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