Credit Application
Please complete application and click submit at the bottom
of the page, or print the screen and fax to 1-877-358-7227 (toll free).
Stock number, or description, of truck(s) you are interested in:
CONTACT INFORMATION
CHECK ALL THAT APPLY: 
First Time Buyer Previous Ownership Experience New Vehicle Used Vehicle

Individual or Partnership

Residentual Phone

E-mail

Cell Phone

Pager

Pager ID

Physical Address

City

County

State

Zip

Mailing Address (if different)

City

County

State

Zip

APPLICANT INFORMATION:
Have you ever financed with Mercedes-Benz Credit: Yes No
Number of trucks you currently:  Operate: Own:

Marital Status: Married Unmarried Separated

Date of Birth: Social Security #:

I am going to operate this vehicle Yes No Years at Present Address:

Years as Owner/Operator: Years as Company Driver

Individual Partnership Commercial Driver's License #:

State Expiration Date Date First CDL Issued

Co- Purchaser's Employer Contact Name # of Years

State City/State Phone # Annual Income

HOME OF PRINCIPAL:

Own/Buying       Mortgage/Property          Taxes per month

Renting per month Live with Relatives

Relative's Name   Relatives Phone #

Nearest Relative Not Living With You

Name  Street Address 

City State  Zip Phone

EMPLOYMENT/TRUCK DRIVING EXPERIENCE
(include last 2 years as a minimum)
CURRENT EMPLOYER:
Street / City / State / Zip:
Starting Date: Phone Number:
PAST EMPLOYER 1:
Street / City / State / Zip:
Starting Date: Ending Date: Phone:
PAST EMPLOYER 2:
Street / City / State / Zip:
Starting Date: Ending Date: Phone:
PAST EMPLOYER 3:
Street / City / State / Zip:
Starting Date: Ending Date: Phone:

TRUCK AND TRAILER CREDIT

 Who Financed Previous Truck and/or Trailer Purchases?

Company

1

2

Phone Number

City/State

Account #

Legal Actions:

 Prior Bankruptcy    Yes No

 Tax Liens                Yes No

 Judgments             Yes No

 Lawsuits Pending   Yes No

BANK INFORMATION

Bank Name

1

2

Phone #

City

State

Account #

Contact

CREDIT REPORT.  By submitting this credit application, I agree to notify Mercedes-Benz Credit Corporation immediately in writing of any material unfavorable change in financial conditions.  Dealer and/or Mercedes-Benz Credit Corporation and its successors (each "Creditor") may obtain my credit report in connection with this credit application, the credit transaction resulting from this application, or future extensions of credit by Creditor, for any aspect of the credit application, including but not limited to reviewing the account, taking collection action, updating credit information or for any other Permissible Purpose under the Federal Fair Credit Reporting Act.  CREDIT INVESTIGATION.  I authorize the Creditor to start a credit investigation based on the information voluntarily provided by me which is true and correct and reflects all my debts.  In addition, I authorize Creditor to obtain federal and state records of employment and income history, including State Employment Security Agency ("SESA") records.  This SESA authorization is for this transaction only and continues in effect for one (1) year unless limited by state law, in which case the authorization continues in effect for the maximum period, not to exceed one (1) year, as allowed by law.  BANKRUPTCY.  A bankruptcy proceeding is not in progress nor expected.  BUSINESS APPLICATIONS.  If the application is submitted in the name of a business, a current and year end financial statement, including P&L statement, and balance sheet is required, audited if possible.  COPY PROVIDED.  Upon request, I will provide a copy of this application.  CERTIFICATION.  Everything I have stated in this application is correct to the best of my knowledge.

 

                            Date