Southland Trucking

Southland International Trucks Inc. - "The Brilliance of Common Sense"

Please take a few minutes to fill out this convenient on-line credit pre-application and we will begin your financial review process. This form is secure so your information is safe. A sales representative from Southland International will contact you as soon as your information is processed. If you would like, you can print this page and fax back to Southland International Trucks, Inc. at (205) 942-6311 to the attention of the Credit Department.

Personal Information (* Required Field)

*Last Name:

*First Name:

*Social Security Number:		(ex. 409870554)

*Date of Birth (Month/Day/Year):

*Phone:

E-mail Address:

*Present Address:

*Present City/Town:

*Present State:

*Present Zip Code:

*Present Country:

*Length of time at present address:

Previous Address:

Previous City/Town:

Previous State:

Previous Zip Code:

Previous Country:

Length of time at previous address:

Employment Infomation (* Required Field)

*Present Employer:

*Employer's Phone:

*Title/Occupation:

Employer's Address:

Employer's City/Town:

Employer's State:

Employer's Zip:

Self Employed?:

Years of Service:

*Gross Annual Income:

*Trucks to be operated for:

*Contact:

*Phone:

*Total Years in Trucking:

*Number of Trucks Owned:

*Number of Trucks Leased:

*Types of use:

*Commercial Driver's License# (State):

*Expires:

Sources of Other Income: (Alimony, Child Support, Optional)

Annual Amount:

Previous Employer:

Previous Employer's Phone:

Previous Title/Occupation:

Previous Years of Service:

Financial Information: Bank/Mortgage References (* Required Field)

*Bank Name:

*Contact:

*Phone:

*City/State:

*Complete Account Number:

Heavy Equipment Financing and Leasing References: include paid out creditor if this information is available (* Required Field)

*Bank Finance Company:

*Contact:

*Phone:

*City/State:

*Complete Account Number:

*Prior Bankruptcy?:

*Prior Repossession?:

Personal Information (* Required Field)

*Residential Status:

Comments or Questions:

*Mother's Maiden Name:

By submitting this credit application, you agree that the information is correct to the best of your knowledge. You also agree to notify us of any changes to your name, address or employment.

You authorize Southland International Trucks, Inc. to obtain credit reports in connection with this request.

�