BUSINESS INFORMATION- *all fields in this section are required.   Legal Name * DBA * Street Address * Year Established * City / State * Years Under Current Ownership * Zip * Date and State Incorporated * Country * State Organization ID# * Contact Name and Title * Federal ID# * Contact Email * Are You Tax Exempt? * Yes No Telephone * Tax ID# * Fax * Business Structure * Corporation Partnership LLC Sole-Proprietorship EQUIPMENT/VEHICLE TO BE FINANCED/LEASED   Year/Make/Model Body/Chassis Vendor Cost Type of Transaction Finance Lease Expected Annual Mileage Fleet Status Addition to Fleet Replacement to Fleet Requested Term OWNERS/PARTNERS/PRINCIPALS   Name (Owner/Partner/Principal) * Title * Social Security Number * Date Of Birth * Home Street Address * % Owned City * Owned Since * State * - - Choose One - - - - US States - - AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY - - Canada Provinces - - AB BC MB NB NL NT NS NU ON PE QC SK YT Phone Number * Zip * Has the Owner Ever Declared Bankruptcy? Yes No   If yes, When?     Name (Owner/Partner/Principal) Title Social Security Number Date Of Birth Home Street Address % Owned City Owned Since State - - Choose One - - - - US States - - AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY - - Canada Provinces - - AB BC MB NB NL NT NS NU ON PE QC SK YT Phone Number Zip Has the Owner Ever Declared Bankruptcy? Yes No   If yes, When? REFERENCES   Business Bank Reference Name Account Number(s) Contact Phone Number     Finance Company Account Number(s) Contact Phone Number Trade Reference (Name/Phone)   SECURITY   Security Code *   For security purposes, please enter the code shown in the above image.   CREDIT INFORMATION RELEASE   By entering your name, and checking the box below, you agree that this Application is an electronic record executed by you using your electronic signature, and you acknowledge and agree to all of the terms set forth below. You also represent and agree that you are authorized on behalf of the Applicant and each Individual named above to enter the information on this Application and to submit this Application to Idaho Wrecker Sales Financial Services.   Name of authorized Agent(s) entering this Application: *   * I Agree to These Terms   I/we certify that the above information given for credit purposes is true and correct and authorize the firm or its agents to whom this application is made and any credit bureau or investigative agency to investigate the references, statements or other data listed on or accompanying the application. I/we authorize all parties contacted to release credit and financial information requested as part of said investigations. If required, I/we will make available all necessary & financial & tax information.