secure business credit application Company Information Legal Business Name: MC# Federal Tax ID# DBA (if applicable) Main Phone Number Email Address Company Street Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC Zip Code Type of Business / Industry: In Business Since Legal Form Under Which Business Operates: C corporation S corporation LLC DBA Partnership Proprietorship If Division or Subsidiary, Name of Parent Company: In Business Since: Source None Mailchimp Google Outside sales Facebook Linked in D&B Fuel card dept Driver Referral Sales Team None Jorge Martinez Dave Espinoza Andres Calderon Desired Equipment Equipment Type Needed: Select 53ft Dry Van Swing door 53ft Reefer Swing door Quantity Needed Desired Term 1 Year 2 Years GPS? Yes No Notes / Specific Equipment Requests: Applicant / Representative Information: Primary Company Principal Responsible for Business Transactions: First Name Middle Name Last Name Date of Birth Title Social # Office Phone Number Mobile Phone Number Email Address Street Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC Zip Code Driver Licence Driver Upload Additional Company Principal Responsible for Business Transactions First Name Middle Name Last Name Date of Birth Title Social # Office Phone Number Mobile Phone Number Email Address Street Address City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC Zip Code TRADE REFERENCES Company Name: Contact Person: Phone Number: Street Address: City: State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC Zip Code: TRADE REFERENCES 2 Company Name: Contact Person: Phone Number: Street Address: City: State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC Zip Code: Credit History Have you, your company officers or affiliates, or your company ever filed a petition in bankruptcy? Yes No Are you, your company officers or affiliates, or your company subject to any litigation? Yes No If you answered yes to either of the above or have items negatively affecting your credit history which require explanation please provide that information here: Acknowlagement I/We certify that all information entered in this application is true and complete. This request is for an AI Trailer Lease Inc billing account. I/We authorize AI Trailer Lease to obtain further information concerning the credit and financial condition of the corporation, principal owner, proprietors, or partners; and to exchange or provide information with other credit grantors. REQUEST AN ESTIMATE