"Everybody Wins US" Lease Application
12·36 Month "Smartway"
Equipment
tease-to-own Program·
10% Down·Payment with $10 Buy Out
Name
Date of Birth __
'__
'__
Social Security #
~
_
Address
City
State
Zip
_
Years at this Address?
DOwn
DRent
Financed?
Mortgage Company
_
Cell Phone
Home Phone
FAX'-----------
E-Mail.
_
Driver's
license #-
State
_
Employer'
Licensed Motor Carrier (LMC)
Position
Years
_
Employer Address:
Phone:
DOwner'operator
DCompany
Will your LMC Guarantee payments? __
Your Gross Monthly Sales or Income $
Primary Routes,
_
Truck Year
Make
Model
Type
_
Engine Year
Make
Model:
VIN #
_
License Plate #
Base Plate State ---------
IFTA or Apportioned?
_
Odometer'
Mileage
Average Miles per Gallon (MPG)
Type Fuel
_
Average Annual Miles
California
Oregon
Washington
_
Is your Truck Financed or Leased?
Who with?
Payoff or Terms?
_
Do you have "Smartway" Equipment
Idle Reduction or APU?
Fairings?
FE Tires
Other
_
Insurance Company
Policy Number
_
Agent Name
Phone _-,--
_
Do you IDLE your main engine on 1-5corridor? __
How many hours? __
Do you spend at least 51% of your time on 1-5?
_
% that you IDLE in California __
Washington __
Oregon __
Sacramento __
San Joaquin __
So California __
Other __
How many hours you have used your APU each year? __
Equipment Financed?
Installer
Price $
_
________________________
Installer
Price $
_
________
.
Installer
Price $.
_
________
Installer
Price $,
_
Total Amount Financed $
Down Payment Amount:
Length of Term
(12-36 months)
Note: For the purpose of verifying the applicant's
financial status and disclosure, please include a copy of the last month's account statement
from the
applicant's primary bank account.
Financial Condition:
the applicant has provided the lessor with information on their financial condition. By signing the lease application, applicant does
hereby declare that the information provided is true and correct and that there has been no adverse change in their financial condition(s) as disclosed to lesso
on their most recent financial statement(s).
Lessor is au