WES-TEX Manufacturing, Inc.
Full Name
Residence - Phone No.
Birth Date (mm/dd/yyyy)
Soc. Sec. No.
Driver Lic. No. (State)
PERSONAL INFORMATION
Business - Phone No.
Soc. Sec. No.
Spouse
Present Address
How Long in Area
How Long at Address
City, State, Zip
Mths.
Mths.
Yrs.
Yrs.
Rent
Own
Old Address:
County:
Company Name
Date of Incorporation
State of Incorporation
Federal ID No.
BANKING INFORMATION
Phone
Contact
Bank
City, State
Acct. No.
1.
2.
Taken Bankruptcy Within 10 Years
Any Repossessions
No
Yes
No
Yes
Relationship
Phone
Name of Relative not living with you
Address
City, State
1.
2.
EMPLOYMENT INFORMATION
Present and Past Employment for the last five years. (current employer first)
Company:
Phone:
Contact:
Position:
How Long:
Address:
Company:
Phone:
Contact:
Position:
How Long:
Address:
How Long as O/O?
Commodities Hauling:
EQUIPMENT PURCHASED
EQUIPMENT/VEHICLES FINANCED
1.
2.
3.
4.
5.
6.
7.
8.
Year
Finance Company
Make
Replacement
Additional
Purchase Price:
Trade-in:
Amount Owed:
Cash Down:
Balance Financed:
Terms:
$
I the undersigned hereby authorize the release of my credit, and request that all loans, credit, bank, trade or other history be given as needed to the funding source. I authorize the use of a faxed copy of this signature to be used as an original when needed for releasing information.
Signature:
Date:
-$
+$
-$
$
Months:
P. O. Box 3313 Lubbock, TX 79452
(800) 687-8660
(806) 749-3789 Fax
All fields are required. Please enter n/a for non-applicable fields.
Year: