Only fill out lease information if this is for a truck or trailer for an owner operator/broker operation based in CANADA. If you are operating more than 3 rigs Please Use Full Business Application Form. Fields marked "*" are obligatory!
I would like to lease a Truck/Tractor Trailer
in Name *
Make * Model * Year * 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996
New? If Not Mileage
Details of unit..*
Est Price (C$). *
Dealer * Sales Rep
Dlr Address
Lease over * 12 24 36 48 60 72 months with a 20% Option 10% Option 15% Option $1 end .
Other term
I am trading * or putting in cash
for a net down payment $ (after payout)
Net to Finance .............. $
Personal Information
First Name*
Last Name.*. Address.....* City .............*.Prov Ont BC Alta Sask Man Que NB NS PEI Nfld Nan NWT Yuk PC
Years there * Rent Own
Home Ph....*.Cell
Soc Ins Number*
Date of birth (mm/dd/yy) *(required for credit check).
E-Mail *
Have you ever declared bankruptcy? Yes No Date Discharged
Has Equipment ever been repossessed from you? Yes No
Trucking Experience
EmployerPh Supervisor
As Owner Operator or as Driver foryears.
Average Weekly KmMthly Gross $
What do you haul?
Typical routes
Prev EmployerPh
Bank Information
Bank....Branch Address
City
ContactPh.
Net Worth Statement If you operate as a Co we shall also require the latest Co year end statement. If you operate as a proprietorship or partnership we shall require latest tax year T1 and T2124 (fax to 905-577-9052) Assets
Net Worth Statement
If you operate as a Co we shall also require the latest Co year end statement. If you operate as a proprietorship or partnership we shall require latest tax year T1 and T2124 (fax to 905-577-9052)
Cash in bank........ Notes Receivable. Stocks & Bonds ..
Life Insurance Cash Value ( do not enter the death value!) Home fmv. Year bought Orig Cost 2nd ppty....Year Bought Orig Cost 1st Tractor.Describe
2nd TractorDescribe
3rd Tractor.Describe 1st Trailer.. Describe
2nd Trailer. Describe
3rd Trailer. Describe Other ....... Describe ................... Describe
Bank Loans....Monthly Payment Other Loans....Monthly Payment Taxes ............... RE Mortgage.. Monthly Payment.(exl taxes) RE Mortgage...Monthly Payment. Credit Cards... Tot min Payment..
Total Owe on 1st Truck Monthly Payment $Months left
Total Owe on 2nd TruckMonthly Payment $Months left
Total Owe on3rd Truck Monthly Payment $Months left
Total Owe on 1st Trailer Monthly Payment $Months left
Total Owe on 2nd TrailerMonthly Payment $Months left
Total Owe on 3rd TrailerMonthly Payment $Months left
As Applicable. Confirm Faxing * Co FS T1 T2124 for Year Ended
Estimate Date Sent
I/We acknowledge that by submitting this Personal Application Net Worth Statement to QEF Consulting Services ("QEF") applicant authorizes QEF or its assign to make enquiries into the Applicant's credit background and to use the information obtained to reach a credit decision. Applicant also authorizes all references herein described and credit reporting agencies to release such information to QEF or its assign.
Authorized by Name Or
Return to Credit & Quote Page
