Call Back Form Construction | 1st Commercial Credit

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company information

Company Name and DBA (if applicable)*

Legal Business Structure*

Business Address*

City*

State*

ZIP Code*

Federal Tax ID #

Date Established*

Company Website

Company Main Phone*

Industry Specialization*

Any Bankruptcies in the last 7 years?*YesNo

owner's information

Owner #1 First Name*

Owner #1 Last Name*

Owner #1 Email (For Documents)*

Phone Number*

Date Of Birth*

Home Address*

State*

City*

Zip Code*

% of Ownership #1*

Social Security # *

Owner #2 First Name

Owner #2 Last Name

Owner #2 Email (For Documents)

Phone Number

Date Of Birth

Home Address

State

City

Zip Code

% of Ownership #1

Social Security #

Current Equipment Assets

Describe Equipment you Own, Buying or Leasing

Total Balance Owed on Equipment

Total Monthly Payments on Equipment

Name of Insurance Company

Total Monthly Insurance Premium

Rent / Building Payment Amount

Landlord Name or Property Lien Holder Landlord / Property Lien Holder Phone #

Landlord or Property Lien Holder Email

Sales and Expenses

Average Monthly Sales

Avg. Monthly Expenses/ Maintenance /Fuel

Last Year Sales

Last Year Taxable Income Amount

Year to Date Sales

Year to Date Net Profit

Ending Bank Statement Balance Last Month

term loans — Banks — financing

Do you have any Short-Term Loans?

If Yes, How much is owed?

Total Receivables (Unpaid Invoices)

Do you use a Factoring Company?YesNo

Equipment to purchase

Describe Equipment to be purchased*

Equipment Cost*

Any Soft Cost?

Any Deposit Amount to Vendor?

Serial or Vin Number

What State will it Be Registered In?

Vendor / Seller Company Name

Vendor Phone Number*

Vendor Sales Person*

Vendor Email*

Current Balances with Trade references

Name of Supplier (1)

City/State

Telephone No.

Contact person

Years/Months as Supplier

Payment Terms (net 30,60)

Balance 0 to 30 days

Balance Past 30 days

Name of Supplier (2)

City/State

Telephone No.

Contact person

Years/Months as Supplier

Payment Terms (net 30,60)

Balance 0 to 30 days

Balance Past 30 days

Name of Supplier (3)

City/State

Telephone No.

Contact person

Years/Months as Supplier

Payment Terms (net 30,60)

Balance 0 to 30 days

Balance Past 30 days

Application Comments

Comments

By submitting this form below, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, authorizes 1st Commercial Credit, LLC and/or debtor and affiliates, successors or its designee (and any assignee or potential assignee thereof) to obtain consumer credit reports relating to his/her individual credit history and/or creditworthiness. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A photostat, electronic signature or facsimile copy of this authorization shall be valid as the original. By signature below, I/we affirm my/our identity as the respective individual(s) identified in this application

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Company information

Company Name and DBA (if applicable)*

Legal Business Structure*

Business Address*

City*

State*

ZIP Code*

Federal Tax ID #

Date Established*

Company Website

Company Main Phone*

MC Authority

DOT #

Owner’s Information

Owner #1 First Name*

Owner #1 Last Name*

Date Of Birth*

Phone Number*

Owner #1 Email (For Documents)*

City*

Home Address*

Zip Code*

State*

Social Security # *

% of Ownership #1*

Any Bankruptcies in the Last 5 years?*
YesNo

Owner #2 First Name

Owner #2 Last Name

Date Of Birth

Phone Number

Owner #2 Email (For Documents)

City

Home Address

Zip Code

State

Social Security #

% of Ownership #1

Any Bankruptcies in the Last 5 years?
YesNo

Truck and Trailer Assets

Number of Power Units Running

Average Miles per Power Unit

Total Monthly Truck Payments

Total Balance Owed On Truck(s)‍

Total Monthly Trailer Payments‍

Number of Trailers Buying/Leasing

Total Monthly Insurance Premium

Name of Insurance Company

Type of Freight Services

Sales and Expenses

Average Monthly Sales

Avg. Monthly Expenses/ Maintenance /Fuel

Average Monthly Fuel Purchase

Outstanding Fuel Card Balance

Last Year Sales

Last Year Taxable Income Amount

Year to Date Sales

Year to Date Net Profit

Ending Bank Statement Balance Last Month

Term Loans – Banks - Financing

Do you have any Short-Term Loans?

If Yes, How much is owed?

Total Receivables (Unpaid Invoices)

Do you use a Factoring Company?YesNo

Equipment to Purchase

Describe Equipment / Truck / Trailer*

Equipment Cost*

Serial Or Vin Number

What State will it Be Registered In?*

Vendor / Seller Company Name

Vendor Phone Number*

Vendor Sales Person*

Vendor Email*

Any Deposit Given?

Current Balances with Trade references

Name of Supplier (1)

City/State

Telephone No.

Contact person

Years/Months as Supplier

Payment Terms (net 30,60)

Balance 0 to 30 days

Balance Past 30 days

Name of Supplier (2)

City/State

Telephone No.

Contact person

Years/Months as Supplier

Payment Terms (net 30,60)

Balance 0 to 30 days

Balance Past 30 days

Name of Supplier (3)

City/State

Telephone No.

Contact person

Years/Months as Supplier

Payment Terms (net 30,60)

Balance 0 to 30 days

Balance Past 30 days

Application Comments

Comments

By submitting this form below, the undersigned individual, who is either a principal of the credit applicant or a personal guarantor of its obligations, authorizes 1st Commercial Credit, LLC and/or debtor and affiliates, successors or its designee (and any assignee or potential assignee thereof) to obtain consumer credit reports relating to his/her individual credit history and/or creditworthiness. Such authorization shall extend to obtaining a credit profile in considering this application and subsequently for the purposes of update, renewal or extension of such credit or additional credit and for reviewing or collecting the resulting account. A photostat, electronic signature or facsimile copy of this authorization shall be valid as the original. By signature below, I/we affirm my/our identity as the respective individual(s) identified in this application

Thank you! Your submission has been received!

A member from our team will respond to you shortly.

Oops! Something went wrong while submitting the form.

Tell us about your company:

Business Name*Email Address*Federal Tax ID #Time In Business*Industry*

Date Established*

City*State/Region*ZIP Code*Legal Structure*

Equipment You Are Purchasing

Are you replacing your vehicle?*YesNoCompany Providing Your Equipment*Is Your Business Address The Same As Your Equipment Address?*
YesNo

Equipment Type*Equipment Cost*

Ownership Information

First Name*Last Name*Owner's Email*Phone Number*

State/Region*Owner's Address*Zip Code*City*

Assets

Cash on hand as of today:Accounts receivable amount:Real Estate Assets:‍Description Of Trucks Owned:

Liabilities

Accounts Payable (Credit Cards, Fuel Bills, etc)Financiers (Loans, Lines of Credit, etc)

Application Comments

Comments

Thank you! Your submission has been received!

A member from our team will respond to you shortly.

Oops! Something went wrong while submitting the form.

Tell us about your company:

Business Name*

City*

Email Address*

State/Region*

Federal Tax ID #

ZIP Code*

Time In Business*

Legal Structure*

Industry*

Equipment and Vendor Information

Describe The Type Of Equipment You Offer

Ownership Information

First Name*

Last Name*

Job Title

Ownership %*

Phone Number*

ZIP Code*

Owner's Email*

City*

Application Comments

Comments

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