MAG Trucks 105 S. Jefferson St. Suite C-3, #271 Kearney, MO 64060 Toll Free: (800)-805-6818Fax: (816)-366-3952 Sales Monday-Saturday 9A.M.-7P.M. Operations 24 Hours CLOSED SUNDAY To : sales@magtrucksales.com Borrower Information (This page is secured with 128 bit SSL encryption ) First Name Last Name Home Address City State Zip Code Months/Years at Residence Example: 4y/6m Primary Phone Alternate Phone Birth Date xx/xx/xxxx Social Security Number (Your application cannot be processed without your SSN) eMail Address Employment Information Employment Status (Self Employed, Employee, Unemployed or Other) Employers Company Name Gross Monthly Income (Before taxes are taken out) Employers Street Address Years & Months of Employment Example: 4y/6m Employers City Employers State Employers Zip Code Employers Phone Your Trade or Occupation Down Payment Available? (Yes, No or a $ amount you will be able to put down) For internal use only Terminal Information (Manager, Telephone, FAX, Address) I certify that the above information is true and correct to the best of my knowledge and hereby give permission to perform credit checks: (Please type your "Full Name" below) Your Digital Signature The undersigned individual who is either a principal, personal guarantor or a sole proprietor of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, herby consents and authorizes us ,or our designees, the use of a consumer credit report on the undersigned signature or digital signature, from time to time as may be needed, as well as the release of any and all information requested for the purpose of granting business credit. A photo copy will act as an original.