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VALLEY WRECKER
SALES, INC
1556 N CLARK, FRESNO, CALIFORNIA 93703
Phone: 800 445-1999 Fax: 559 485-7835
This form is
available as a adobe PDF File to
download and Print.
| Company Name |
Tax ID |
Phone |
| Address |
Type of Entity
(Proprietorship, Partnership, C Corp, S Corp) |
| City |
State |
Zip |
County |
Date Incorporated & State |
| Materials Hauled |
Years In Business |
Years Industry Exp. |
| Description of Business |
Number of Trucks In Fleet
#
Heavy
#Med Duty |
# Employees |
| Important!
Include credit references from current/past/truck/trailer leases/loans in
section below. |
| Lessor/Creditor/Trucks |
Phone |
Yr Opened |
Orig Bal |
Curr Bal |
Payment |
Equipment |
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| Bank Name |
Yr Acct Opened |
Checking Acct # |
Checking Acct Balance |
| Contact |
Phone # |
Line of Credit Limit |
Line of Credit Available |
Ever Been Bankrupt?
Yes No
If Yes / Year
________ |
Ever had a
Repossession? Yes No |
Any Taxes Currently Due?
Yes No |
| Required for Leasing -
Insurance Carrier |
Contact |
Phone # |
| Majority Owner Name |
Percent Ownership |
Date of Birth |
| Address |
Home Phone # |
Social Security # |
| City |
State |
Zip |
Monthly Income |
Monthly Housing Payment |
Current Residence?
Own
Rent |
Time at Current Residence
(yrs/mos) |
Mortgage Holder |
Personal Net Worth |
| Second Owner/Guarantor Name |
Social Security # |
Date of Birth |
| Name of Relative or acquaintance
not residing with you |
Relationship |
Phone # |
| Please provide the following
information on 3 current towing contracts. |
|
Contract
1 |
Contract
2 |
Contract 3 |
| Company Name |
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Contact |
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Phone # |
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The information given above is true and complete. Valley Wrecker
Sales Inc. and its Assignees may receive from and disclose
to other persons, including credit reporting agencies, information about
Applicant's accounts and credit experience and Applicant authorizes any
person to release to Valley Wrecker Sales Inc. and its
Assignees credit experience and account information on Applicant.
This shall be a continuing authorization for all present and future
disclosures of account information and credit experience on Applicant made
by Valley Wrecker Sales Inc. and its Assignees, or any person
requested to release such information to Valley Wrecker Sales
Inc. and its Assignees.
By _________________________________(Signature)
By ________________________________(Signature)
Date
__________
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