Dale's Truck Sales Logo
SPECIALIZING IN HEAVY TRUCKS WHOLESALE & RETAIL
 
203 S.W. 24th Street • Ft. Lauderdale, FL 33315 • Office: 954-522-2136 • Fax: 954-527-1603
         
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Please complete form, print and sign in designated area of form. Then fax to 954-527-1603.

CREDIT APPLICATION

Personal Information

First Name:

Middle Name:

Last Name:

SS# :    Date of Birth:

Present Address:

City:    State:     Zip:

Time @This Address Yrs-Mths:

Home Phone :    Cell Phone:

Nearest Relative Not Living With You. Relation:

Relative Not Living With You. Address :

Relative's Phone:

Previous Address:
(if less than 3 yrs at present address)

City:    State:     Zip:

EMPLOYMENT HISTORY


Present and past employment in the past 5 years.

Employer :    Employer Phone:

Contact :   Position:

Employer Address:

City:    State:     Zip:

How Long :

Describe Nature of Business:

Monthly Income :    Other Income :

Source:

Signature :   Date:

 

Year:    Make:    Model:

Engine:    Transmission:

Cost:

 
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