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Credit Application

Daimler Truck Financial Bus & Coach Credit Application

Customer Data

Today's Date
 Business Start Date
Tax ID # State of Incorporation
C Corp S Corp LLC Partnership Sole Proprietorship
Parent Company (if applicable)
Customer Legal Name DBA Name
Address
Primary Email Address Website
City County State Zip Tel # Fax #
Principal Owner/Guarantor Name Title SSN % Owned Years with Co. Years Experience
Principal Owner/Guarantor Name Title SSN % Owned Years with Co. Years Experience
Principal Owner/Guarantor Name Title SSN % Owned Years with Co. Years Experience

Finance/Insurance Information

Bank Name
Checking Account # Contact name Tel #
Bank Name
Operating Line #
Contact name Tel #
Operating Line Secured By: Accounts ReceivableAll AssetsPersonal GuarantyOther
Vehicle Finance Reference Account #
Contact name Tel #
Vehicle Finance Reference Account #
Contact name Tel #
Vehicle Finance Reference Account #
Contact name Tel #
Any units financed with Mercedes-Benz
Financial Services USA LLC?
YesNo 		Account #
Account name
Insurance Agency
Contact Name
Liability Coverage
$ 		Phys Dam. Ded.
$ 		Tel #

Major Customers

Name % Revenue How Long?
Years Months 		Contact name Tel #
Name % Revenue How Long?
Years Months 		Contact name Tel #
Name % Revenue How Long?
Years Months 		Contact name Tel #

Equipment Information

Current Fleet # School Buses # Coaches
# Vans Transit Buses Total # Units To Be Purchased/Leased
# Additions To Fleet # Replacements to Fleet # New Or Current Contract # Anticipated Dlvry date:
School Bus ContractorDay CareChurchOther
Is Business Seasonal? YesNo
Inactive month(s)
Equipment Operates: LocalInterstateRegionalIntrastate
RetailTRACOBS TRACFMVFixedFloat # Months
Baloon/Residual
%		 Payment Stream
LevelSkips (Months)

*********TFFF2238 (08/01/2011) F&I Pro Bus Coach

AUTHORIZATION TO CONDUCT A CREDIT INVESTIGATION

If applying for credit, please sign this authorization (“Authorization”). By signing this Authorization:
  1. I authorize Dealer, Mercedes-Benz Financial Services USA LLC, (“MBFS”), Daimler Trust and any finance company, bank, or other financial institution to which the Dealer or MBFS and/or Daimler Trust submits my application (“You” or “Your”) to investigat e my credit and employment history (if an individual), obtain credit reports, contact any of my current or former creditors to verify any information contained herein or received in connection with this Authorization or the accompanying credit application which You de em relevant to the possible extension of credit to me (“Information”), and release Information about Your credit experience with me as the law permits.I authorize MBFS or Daimler Trust to disclose Information to any affiliate, assigns or agent.
  2. I authorize MBFS or Daimler Trust to file a UCC Financing Statement.
  3. I intend to use the purchased or leased Equipment primarily for business or commercial purposes, and not for personal, family,household or agricultural purposes.
  4. If an account is created, I authorize You to obtain credit reports for the purpose of reviewing or taking collection action on the account,or for other legitimate purposes associated with the account.
  5. I certify that I have read and agree to the terms of this Authorization and the accompanying credit application and that the information in both documents is complete and true.
  6. If I am an individual, I authorize the release of federal and state records of my employment and income history. A bankruptcy proceeding is neither in progress nor expected. If the accompanying credit application is submitted in the name of a business, a current and year-end financial statement, including P&L statement and balance sheet, may be required, audited if possible. I will notify MBFS and Daimler Trust if I become aware of any material change in my financial condition.
  7. I consent and agree that MBFS, Daimler Trust, and any successors, affiliates, agents or service providers may to the extent permitted by law; (i) monitor and record telephone calls concerning my account to assure quality of service or for other reasons; and (ii) use written, verbal, and electronic means to contact me, including, without limitation, manual calling methods, prerecorded or artificial voice messages, text messages, e-mails and/or automatic dialing systems. Such means of contact may include use of an e-mail address or any telephone number I provide, now or in the future,including a cellular phone or other wireless device number, regardless of whetherI incur charges as a result.

CALIFORNIA RESIDENT: Applicant, if married, may apply for a separate account.


MAINE, RHODE ISLAND, AND TENNESSEE RESIDENTS: You must have physical damage insurance covering loss or damage to the vehicle forthe term of any contract. For a lease, you must also have the liability insurance as described in the lease. You may buy this insurance from anyone you choose. You do not have to buy it from or through someone affiliated with the dealer or an assignee of this contract. Your choice of insurance will not affect the credit approval process unless the insurance does not satisfy the contract requirements or the insurance company does not satisfy the reasonable standards of the dealer or an assignee of the contract.


NEW YORK RESIDENT: Consumer reports may be requested in connection with this application. Upon your request, you will be informed as to whether or not a consumer report was requested
and informed of the name and address of the consumer reporting agency that furnished the report. On any update, renewal or extension of this credit, subsequent consumer reports may be requested.


OHIO RESIDENT: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.


Borrower Name (print): Guarantor Name (if applicable-print):
Borrow Signature: Guarantor Signature:
Title:
(Only applicable if Co-Borrower is NOT an individual)		 Title:
(Only applicable if Co-Borrower is NOT an individual)
Date: Date:
 
Co-Borrower Name (print): Co-Guarantor Name (if applicable-print):
Co-Borrow Signature: Co-Guarantor Signature: (if applicable):
Title:
(Only applicable if Co-Borrower is NOT an individual)		 Title:
(Only applicable if Co-Borrower is NOT an individual)
Date: Date:

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