JAG TRUCK SALES
Secure Loan Application

Primary Borrower Information

Loan Information

Personal

Individual Partnership Corporation
- -
/ /
- -
Years
Years
No Yes
No Yes
No Yes

Employment

No Yes
Years
Months
Years
Months
Yes No
Years
Months

Financial Information

value
value
value
value
This information given above is true and complete. Jag Truck Sales and its assignees may receive from and disclose to other persons including credit reporting agencies, information about Applicant's accounts and credit experience, and Applicant authorizes any persons to release to credit experience and account information on Applicant. This shall be a continuing authorization for all present and future disclosures of account information on Applicant made by Jag Truck Sales.

By submitting this application, I certify that all information herein is true and complete. I agree I am providing this information to the dealer identified in this application and acknowledge that my information may be shared pursuant to the dealer’s privacy policy, if applicable. I hereby authorize this dealer, and any financial institution engaged as a service provider by this dealer, to retain this application and to check and verify my credit, employment and salary history. By submitting this application, I acknowledge I am authorizing this dealer to check my credit.