Brown
Truck Leasing Corp.
2525 E Euclid, Suite 214
Des Moines, IA 50317
1-800-811-3515
Credit Application
Personal Information
Individual or Company Name:
Street Address:
City:
State:
Zip:
Phone:
Fax:
E-mail:
If company, type of ownership:
Corporation
Partnership
Individual
Principal owners:
Application for credit is hereby made and the following references given. It is understood this information will be held in the strictest of confidence and used only by your Credit Department.
Banks
Checking Account
Name:
Contact Person:
Address:
Phone:
Fax
Savings Account
Name:
Contact Person:
Address:
Phone:
Fax
Business References where credit now extended
Name:
Address:
Phone:
Fax
Name:
Address:
Phone:
Fax
Name:
Address:
Phone:
Fax
Name:
Address:
Phone:
Fax
The above information is for the purpose of obtaining credit and is warranted to be true. I/We hereby authorize Brown Truck Leasing Corp. to investigate the references listed pertaining to My/Our credit and financial responsibility.
Signed:
Title:
Date: