thank you for taking the time to apply for the db kustom
TRANSCRIPT
Thank you for taking the time to apply for the DB Kustom Trucks
program. The application is a two part process:
1. Apply to drive for Quality Carriers, North America ’s largest tank
truck company.
2. Apply for financing to purchase your own DB Kustom Truck along
with the guidance and help of two of the country’s premier Owner
Operators to insure your success.
Once the applications are completed, you will be contacted by a DB
Kustom Truck specialist to help walk you through the process and into
your Kustom ride as quickly as possible.
Please follow the two application guides in this packet to insure our
specialists have all the information they need to help get you into your
new Kustom truck as quickly as possible.
Thank you for your interest in our Kustom truck program and the entire
DB Kustom Trucks Team looks forward to working with you.
The DB Kustom Trucks Team.
Please go to the website address below to complete an application:
work4qc.com
Once at the website address:
Click on the button in the upper right hand
corner to access the online application.
Complete all information requested.
On the second page, please select the following from the drop
down boxes for the following questions:
Once the application is completed please submit.
The DB Kustom Trucks specialist will be in touch with you to
complete your application and to schedule you into our
training program.
Please complete the following documents:
Credit Application ("Individual Purchaser Statement")
Complete
Legible
No White Out
Original Signature (no stamped signature)
Crossroads Reference Sheet
Top Section Only (Personal References; Business not needed)
Complete
Legible
No White Out
Copy of your valid CDL
Front and back copies.
Enlarged
Clear Copy
Utility Bill
From within the past 30 days
Pay Stub/Settlement
From within the past 30 days
Return all five completed documents to:
Jessica Fernandez
Email: [email protected]
Fax: (813) 569-1699
CROSSROADS EQUIPMENT LEASE & FINANCE, LLC INDIVIDUAL PURCHASER/LESSEE STATEMENT
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INDIVIDUAL/PARTNERSHIP INFORMATION: 1st :nwO :etarepO :yltnerruc uoy skcurt fo rebmuN .pxE pihsrenwO reyuB emiT
:htriB fo etaD :rebmuN ytiruceS laicoS :emaN lluF
rebmuN regaP rebmuN enohP emoH Cell Phone Number E-Mail Address
:piZ :etatS :ytnuoC :ytiC :sserddA gniliaM/lacisyhP tneserP
How Long at Present Address? Years: Months:
Rent Own Live with relatives Monthly Payment:
Previous Address (If less than 2 years)
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NEAREST RELATIVES/PERSONAL REFERENCES NOT LIVING WITH YOU: Name
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CORPORATION/LEGAL ENTITY INFORMATION (If Applicable) Exact Legal Name of Corporation/Legal Entity: Inc. LLC Other Federal ID#
Year of Organization
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Title % Owned US DOT rebmuN CM rebmuN
CURRENT EMPLOYMENT INFORMATION Total Years of Driving Experience Years as revirD ynapmoC sa sraeY rotarepO renwO
:enohP :etatS :ytiC :emaN
emocnI shtnoM reyolpmE tnerruC ta sraeY tcatnoC
Other Annual Income rehtO rotarepO renwO revirD ynapmoC Amount ecruoS
FUTURE EMPLOYMENT rebmuN enohP etatS/ytiC emaN
diaP euneveR ylhtnoM seliM ylhtnoM tcatnoC/mile % of Gross
etatS #LD laicremmoC deluaH eb ot stcudorP
PREVIOUS EMPLOYERS ?gnoL woH tcatnoC rebmuN enohP etatS ytiC emaN
?gnoL woH tcatnoC rebmuN enohP etatS ytiC emaN
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Salesperson’s Name:
LESSEE STATEMENT Trucks/Trailers Owned Description of Collateral
Lending Institution City/State Phone # Account #
Real Estate Lending Institution City/State Phone # Account #
Autos Owned Lending Institution City/State Phone # Account #
Bank Account Type Institution City/State Phone # Account #
Authorization to Release Credit InformationThe undersigned certifies that: (a) all of the information contained herein or provided in connection with this Application is true and correct and accurately describes the financial condition of the Customer(s) as of the date hereof; and (b) I will notify Crossroads Equipment Lease & Finance LLC, its successors and assigns ("Creditor") if I become aware of any material change in the financial condition of the Customer(s). I hereby authorize Creditor and/or Dealer to make inquiry into, to request, and to receive any information concerning my financial condition, including, but not limited to, obtaining a credit report and contacting any current or former creditors of Customer(s) to verify any information contained herein or received in connection with this Application, which Creditor and/or Dealer deems relevant to the possible extension of credit to Customer(s) (“Information”). I also grant any such creditors permission to release Information to Creditor and/or Dealer. I authorize Creditor to disclose Information to any affiliate, assigns or agent. I authorize Creditor to file a UCC financing statement. I have applied for a loan or extension of credit from Creditor and I intend to use the purchased Equipment primarily for business or commercial purposes, and not for personal, family, household or agricultural purposes. The foregoing provision shall remain in effect until Customer pays
Creditor in full (if Creditor decides to grant credit to Customer(s)).
Applicant Signature: Title (if applicable): Date:
Co-Applicant: Title (if applicable): Date:
Type of Application: Business Individual Used New Retrofit
V160.12102012-CJR
Buyer/Borrower/Lessee Name and Address Creditor/Lessor Name and Address
Crossroads Equipment Lease & Finance, LLC
9121 Haven Avenue, Suite 270
Rancho Cucamonga, CA 91730
Account Number:
Date:
PERSONAL REFERENCES
Reference 1
NAME: RELATIONSHIP Verified:
ADDRESS: CITY: BY:
STATE: ZIP: PHONE EMAIL: DATE:
Reference 2
NAME: RELATIONSHIP Verified:
ADDRESS: CITY: BY:
STATE: ZIP: PHONE EMAIL: DATE:
Reference 3
NAME: RELATIONSHIP Verified:
ADDRESS: CITY: BY:
STATE: ZIP: PHONE EMAIL: DATE:
Reference 4
NAME: RELATIONSHIP Verified:
ADDRESS: CITY: BY:
STATE: ZIP: PHONE EMAIL: DATE:
Business References
Trade References Bank References
Name of Company:___________________________________________________
Name of Contact:_____________________________________________________
Company Address:____________________________________________________
Telephone Number:___________________________________________________
Account Number____________________________________________________
Name of Company:______________________________________________________
Name of Contact:________________________________________________________
Company Address:______________________________________________________
Telephone Number:______________________________________________________
Account Number________________________________________________________
Name of Company:___________________________________________________
Name of Contact:_____________________________________________________
Company Address:____________________________________________________
Telephone Number:___________________________________________________
Account Number______________________________________________________
Name of Company:______________________________________________________
Name of Contact:________________________________________________________
Company Address:______________________________________________________
Telephone Number:______________________________________________________
Account Number________________________________________________________
Name of Company:___________________________________________________
Name of Contact:_____________________________________________________
Company Address:____________________________________________________
Telephone Number:___________________________________________________
Account Number_____________________________________________________
Name of Company:______________________________________________________
Name of Contact:________________________________________________________
Company Address:______________________________________________________
Telephone Number:______________________________________________________
Account Number________________________________________________________