STAN KOCH & SONS TRUCKING PHONE 763-302-5741 EMAIL [email protected] 4200 DALHBERG DR MINNEAPOLIS MN 55422 [email protected] COMMERCIAL CREDIT APPLICATION COMPANY NAME/INDIVIDUAL/TRADE NAME/DBA GENERAL INFORMATION FEDERAL TAX ID# STREET ADDRESS BILLING ADDRESS CITY/STATE/ZIP CITY/STATE/ZIP TELEPHONE # FACSIMILE# TYPE OF BUSINESS SALES TAX EXEMPT # DATE ESTABLISHED UNITS IN FLEET PLEASE CHECK ONE ________ # OF TRACTORS ________ # OF TRUCKS ________ # OF TRAILERS ____ INDIVIDUAL____ CORPORATION____ PARTNERSHIP ANY REPOSSESSIONS ANY BANKRUPTCIES FILLINGS ___________ YES ____________ NO _________ YES _________ NO ARE FINANCIAL STATEMENTS AVAILABLE __________ YES __________ NO FULL NAME OF OWNER(S) (OR AUTHORIZED OFFICER OF CORPORATION), LIST HOME ADDRESS & ZIP CODE FOR PARTNERSHIP OR INDIVIDUAL NAME TITLE CITY/STATE/ZIP SOCIAL SECURITY # NAME TITLE CITY/STATE/ZIP INSURANCE COMPANY CITY/STATE/ZIP COMPLETE NAME CITY/STATE/ZIP SOCIAL SECURITY # INSURANCE INFORMATION TELEPHONE # POLICY # TELEPHONE # CONTACT ACCOUNT # CITY/STATE TELEPHONE # EMPLOYMENT CREDIT REFERENCES COMPLETE NAME CONTACT PERSON COMPLETE NAME CONTACT PERSON ACCOUNT # CITY/STATE TELEPHONE # COMPLETE NAME CONTACT PERSON ACCOUNT # CITY/STATE TELEPHONE # COMPLETE NAME CONTACT PERSON ACCOUNT # CITY/STATE TELEPHONE # COMPLETE NAME CONTACT PERSON ACCOUNT # CITY/STATE TELEPHONE # BANK REFERENCES NAME OF BANK CHECKING ACCT # CITY/STATE LOAN OFFICER NAME OF BANK TELEPHONE # CHECKING ACCT # LOAN OFFICER CITY/STATE TELEPHONE # APPLICANTS SIGNATURE HEREBY WARRANTS THE TRUTH AND ACCURACY OF THE ABOVE INFORMATION. AS PART OF THE APPLICATION FOR CREDIT, WE HEREBY GRANT PERMISSION TO CONTACT CONSUMER CREDIT REPORTING AGENCIES, COMMERCIAL CREDIT REPORTING AGENCIES, AND ANY OR ALL OF THE TRADE AND BANK REFERENCES LISTED ABOVE, TOGETHER WITH ANY OTHER REFERENCES WHICH MAY BE PROVIDED BY THESE SUPPLIERS, TRADE, CREDIT, AND BANK REFERENCES. IF APPROVED, WE AGREE TO PAY ALL CHARGES ACCORDING TO THE TERMS AND CONDITIONS AS STATED BY KOCH-NATIONALEASE, A DIVISION OF STAN KOCH & SONS TRUCKING, INC. IF WE FAIL TO DO SO, THEN WE AGREE TO PAY ANY LATE CHARGES, COLLECTION EXPENSES, ATTORNEY FEES OR SERVICE CHARGES IF COLLECTION PROCEDURES ARE INSTITUTED. DATE ________________________ SIGNATURE: _____________________________________________ TITLE ________________________________________________