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Phone: 727-585-1500, Fax: 727-585-1316
Email: cori@interglobal1.com
CREDIT APPLICATION
Date
Equipment Cost
Year, Make, Model Term Requested (months)
Down Payment/Trade-in Allowance
Purchasing From
Delivery Date
New or Used
Contact Person
APPLICANT INFORMATIONBusiness Legal Name (and DBA)
Federal Tax ID #
Street Address
City/State/Zip
Principal Contact
Type of Business
Phone #
State of Incorporation
Date of IncorporationFax #
Business Type: FORMCHECKBOX Prop FORMCHECKBOX C-Corp FORMCHECKBOX S-Corp FORMCHECKBOX LLC FORMCHECKBOX LLP FORMCHECKBOX C-CORP Years in Business Annual Revenue Approximate number of Employees PRINCIPAL OWNER / GUARANTOR INFORMATIONName and Title
% Ownership
Date of Birth
Social Security Number
Home Address Home Phone Number
Name and Title
% Ownership
Date of Birth
Social Security Number
Home Address
Home Phone Number
Name and Title
% Ownership
Date of Birth
Social Security Number
Home AddressHome Phone Number
Name / Corporate GuarantorRelationship to Applicant
Federal Tax ID #
AddressTelephone Number CURRENT FLEET INFORMATION Company Owned Tractors: Company Owned Trailers: Is purchase addition or replacement?Owner Operators Tractors: CREDIT INFORMATIONBank - Address
Bank AddressPhone Contact
Phone - Contact
Checking Account #
Operating Line Account #
EQUIPMENT DEBT REFERENCES:
Name Location
Phone Number Account Number
1.
2.
3.
Credit Application (page 2)
MAJOR CUSTOMERS:
Name Number of years
% of Total revenue Type of freight hauled
Insurance Agent:
Phone Number:
Address:
Contact Person:Liability Coverage Limit:
Physical Damage Deductible:
The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status or age (provided the applicant has the capacity to enter into the binding contract); because all or part of the applicants income derives from any public assistance program; or because the applicant has in good faith exercised any right under the consumer Credit Protection Act. The federal agency that administers compliance with this law concerning this creditor is the Office of the Comptroller of the Currency, Customer Assistance Group, 1301 McKinney St., Suite 3450, Houston, TX 77010-9050. If for any reason your application for business credit is denied, you have the right to a written statement of the specific reasons for the denial. To obtain the statement, please write to Interglobal Capital Inc. 1180 Ponce de Leon Clearwater, Fl. 33756 or call the representative listed at the top of this application within 60 days from the date you are notified of our decision. We will send you a written statement of reasons for the denial within 30 days of receiving your request for the statement.
REPRESENTATIONS/AUTHORIZATION(s)
I/We for ourselves and as owner(s)/officer(s)/partner(s)/guarantor(s) of the Applicant certify to Interglobal Capital that all of the information set forth in this Application (and in any other documents submitted in connection with the Application) may be relied upon by Interglobal Capital Inc. as being true and correct. I/We agree to promptly notify Interglobal Capital Inc. of any changes. I/We understand that this Application and attachments will remain the property of Interglobal Inc. even if the lease/loan is declined. I/We for ourselves and as owner(s)/officer(s)/partner(s)/guarantor(s) of the Applicant authorize Interglobal Capital Inc. to obtain any information Interglobal Capital Inc. requires, relating to my/our creditworthiness from any source, including a credit reporting agency, any time during the term of the lease/loan or while any balance is outstanding or if Interglobal Capital Inc. updates, renews or extends this loan. On request, Interglobal Capital Inc. will provide me with the name and address of the consumer reporting agency that furnished the report. I/We for ourselves and as owner(s) officer(s) partner(s)/guarantor(s) of the Applicant certify that the proceeds of this loan if approved will be for business use only.
1. Signature: Date
2. Signature: DatePrinted Name:Printed Name:
IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.
What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.
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