JX | Just a Draft

JX Truck Purchase Credit App

By marking this box, I consent to do business with JX
Credit Application
Pick One
Today's Date
MM slash DD slash YYYY
Sales Rep
Dealership Location
City
F&I Rep
Legal Business Name or Borrower's Name
FEIN/SSN
Inc. Date
MM slash DD slash YYYY
Primary Phone Number
Homeowner?
Current Address
City State ZIP Code
Garaging Address
City State ZIP Code
Type of Business
List Owners, Officers, or Members
Owner 1
SSN
DOB
MM slash DD slash YYYY
Home Address
City State ZIP Code
% Ownership
Email
Owner 2
SSN
DOB
MM slash DD slash YYYY
Home Address
City State ZIP Code
% Ownership
Email
List 3 Haul References or 3 Years Employment History
Company Name
Company City & State
City State
Contact Name
Contact Phone
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Goods Hauled
Company Name
Company City & State
City State
Contact Name
Contact Phone
Goods Hauled
Start Date
MM slash DD slash YYYY
Start Date
MM slash DD slash YYYY
Company Name
Company City & State
City State
Contact Name
Contact Phone
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Goods Hauled
# of Years as an Owner Operator or In Business
# of Years as a Company Driver
Do you have your own authority?
Authority Number
Do you team?
Legal Actions
Have you ever filed bankruptcy?
If so, please provide the date filed
MM slash DD slash YYYY
Do you have any pending lawsuits?
Any judgements or collections?
Any prior repossessions?
Any tax liens?
Current Equipment Owned or Leased
If you do not currently own or lease any equipment, please fill the following fields as "N/A"
Description, year, and make
Where Financed?
Contact Name
Contact Phone
Balance Owed
Description, year, and make
Where Financed?
Contact Name
Contact Phone
Balance Owed
Description, year, and make
Where Financed?
Contact Name
Contact Phone
Balance Owed
Equipment to be Purchased
Description
Stock Number
Sale Price
Is this additional or replacement equipment?
Reason for adding equipment?
Requested Down Payment
Trade Description
List 2 Nearest Relatives
Name
Current Address
City State ZIP Code
Phone
Relationship
Name
Current Address
City State ZIP Code
Phone
Relationship
Privacy Waiver Signature
The undersigned credit applicant, principal of a credit applicant, or guarantor of a credit applicant, provides written authorization to JX Financial, Inc., its agents and affiliates, in conjunction with a commercial loan or lease application. JX Financial, Inc. is authorized to obtain credit bureau reporting, credit and employment history, insurance information, and any and all further information necessary to process the application for credit subsequently for the purpose of update, renewal, or the extension of such credit or additional credit and for reviewing and collecting any resulting accounts. JX Financial, Inc. may also release any information obtained to its affiliates, lenders, participants, prospective purchasers or assigns, provided that such disclosure should only be for the purpose of evaluating the application for credit, or the update, renewal, or the extension of such credit or additional credit, or for reviewing and collecting any resulting accounts. A .pdf or facsimile copy of this authorization shall be valid as the original. I understand that credit inquiries have the potential to impact my credit score. I acknowledge this authorization relates to commercial financing and is not for any household, family, or consumer purpose. Facsimile photocopy or .pdf copies of this authorization may be treated as originals.
Applicant Name*
Signature*
Please provide authorized personal signature here
Date*
MM slash DD slash YYYY
Applicant Name
Signature
Please provide authorized personal signature here
Date
MM slash DD slash YYYY
Are you interested in receiving updates on any of the following?
- New/Used Truck Specials
- Parts/Service Specials
- Lease/Rental Specials
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JX Truck Purchase Credit App

Credit Application

List Owners, Officers, or Members

List 3 Haul References or 3 Years Employment History

Legal Actions

Current Equipment Owned or Leased

Equipment to be Purchased

List 2 Nearest Relatives

Privacy Waiver Signature