Kenworth Truck Centres

Truck Credit Application

Business and Personal Information:

Legal Company Name:

Phone Number:

Address:

City:

Postal Code:

Full Name:

Email:

Address:

City:

Postal Code:

Date of Birth:

Social Insurance Number:

General Questions:

Years in Business:

Years Driving Truck:

How many trucks do you have:

Is this

An Additional Truck

Replacement Truck

First Truck

Where have you financed trucks in the past:

Net Worth Statement:

Value of Home:

Mortgage Balance:

Value of Vehicles:

Balance Owing on Vehicles:

Value of Other Assets:

Credit Card Balances:

Total Net Worth Per Above Details:

Supporting Documentation:

Company Financial Statements (if business):

Job letter confirming monthly revenue (if this is your first truck):

Driver Information:

Who Will Truck Work For:

Contact Name & Phone #:

# Of Years There:

Authorization:

I certify the above information to be true and complete. I authorize and consent to the receipt and exchange of credit and personal information about myself, including the sharing and exchanging of such information (automatically or upon request) about myself with any credit reporting agency and any credit bureau and any person or corporation with whom I have or have had financial relations.

For the purpose of establishing and maintaining credit, the undersigned submits the foregoing statement and information contained on this form as being a full, true and correct statement of my financial condition on the date stated. The undersigned hereby authorized Kenworth Toronto Ltd. and/or any potential 3rd party credit grantors (“Kenworth”) to make inquiry into, to request, and to receive information from any source, including but not limited to creditors, credit reporting agencies and credit bureaus which Kenworth deems relevant for the granting and collection of the proposed borrowing and furthermore Kenworth is authorized to disclose in response to direct inquiries from any other lender or credit bureaus, such information on my account as Kenworth consider appropriate and I agree to indemnify Kenworth against, and save Kenworth harmless from any and all claims in damages or otherwise arising from such disclosure on your part. I understand that Kenworth Toronto Ltd. and/or any seller of motor vehicle parts, services or financing to whom this application is presented will be relying on the accuracy of the matters set forth herein as a basis for extending any credit which I may receive.

The personal information provided herein may be used for a) evaluating credit worthiness, b) assessing the risk of extending credit, c) account administration and collection and d) marketing and selling of other products and services within the dealership network, and the undersigned consents to such use and the disclosure of information for such purposes.

Signature *

Date *

By clicking on "Submit", I agree to be legally bound by the above terms.