Credit Application

Please fill out the form below and do not navigate away from the page or the fields will be reset.

Applying for:*
- Lease
- Rental
- Maintenance
Legal Name of Business:*
Subsidiary Of (if applicable):
Years in Business:*
Structure:*
- Corporation
- Partnership
- Proprietor
- Other
Date of Incorporation:*
Month
Day
Year
Type of Business:*
Is a PO # Required?*
- Yes
- No
Have You Ever Filed Bankruptcy?*
- Yes
- No
Federal I.D. No.:*
Tax Status:*
- Not Exempt
- Exempt
*Must Include Copy of Tax Certificate Application for WI
Accepted file types: jpg, gif, png, pdf, doc, docx, Max. file size: 50 MB.
DOT Number:*
Name of Company's First Officer/Owner:*
Accounts Payable Information
AIP Contact Name:*
AIP Contact Phone:*
AIP Contact Email:*
AIP Contact Fax:
We can email invoices. If that is your prefered method of receiving invoices, please complete below:
Maintenance/PM Email:*

Person to receive email when unit is due for maintenance or oil change.
Lease/Rental Email:*

Person to receive email invoices for lease and/or rental unit(s).
Service Email:*

Person to receive invoices for service work.
Trade References
Reference #1:
Company:*
Phone:*
Fax:
Email:*
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference #2:
Company:
Phone:
Fax:
Email:
Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference #3:
Company:
Phone:
Fax:
Email:
Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Reference #4:
Company:
Phone:
Fax:
Email:
Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Bank:
Bank Name:*
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone:*
Contact:*
Credit Limit Requested:*
Payment Requirement for Lease & Rental:

This application is made with the understanding that the total amount charged to my account is payable upon receipt of invoice or statement. If the account balance is past due by 2 weeks, Valley Truck Leasing, Inc. will request the unit(s) returned to our location. A monthly finance charge of 1% (12% annually) or $15, whichever is greater, will apply to all past due amounts, and be added to the outstanding balance. Valley Truck Leasing, Inc. has the right to limit the amount of credit extended. I hereby authorize Valley Truck Leasing, Inc. to obtain the necessary credit information to substantiate this application. All information will be handled in a confidential manner.

Payment Requirement for Maintenance:

This application is made with the understanding and agreement that the total amount charged to my account is payable upon receipt of invoice or statement. If the account balance is past due by 2 weeks, Valley Truck Leasing, Inc. will suspend the account. A monthly finance charge of 1% (12% annually) or $15, whichever is greater, will apply to all past due amounts, and be added to the outstanding balance. Valley Truck Leasing, Inc. has the right to limit the amount of credit extended. I hereby authorize Valley Truck Leasing, Inc. to obtain the necessary credit information to substantiate this application. All information will be handled in a confidential manner.
Name:*
First Last
Title:*
By selecting the “Submit" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting “ Submit" you consent to be legally bound by this Agreement's terms and conditions.

^* Required Fields.

Menu

Credit Application
for Valley Truck Leasing.

Credit Application

Accounts Payable Information

Trade References

Reference #1:

Reference #2:

Reference #3:

Reference #4:

Bank:

Menu

Credit Applicationfor Valley Truck Leasing.

Credit Application

Accounts Payable Information

Trade References

Reference #1:

Reference #2:

Reference #3:

Reference #4:

Bank:

Credit Application
for Valley Truck Leasing.