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Call Us: 815-923-0100 | For Used Parts: 224-747-2007

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CREDIT APPLICATION

Hodges Westside Truck Center

Primary Borrower Information

Personal

Name(Required)

First Middle Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Social Security Number(Required)

Date of Birth(Required)

Gross Salary(Required)

Mortgage/Rent Payment (per month)(Required)

Residence Type

How long have you lived at this address?(Required)

If you have lived at your current residence less than 5 years, please enter your prior address

Are you a business owner?(Required)

No

Yes

Business

Business Name

Federal Tax ID

Business Phone

Business Billing Address

Street Address Address Line 2 City State ZIP Code

Type of Business/Trade

Gross Profit (Monthly)

Ownership %

Prior Experience

State of Incorporation

Date Established

# of Years of Experience

# of Vehicles in Fleet

Repossession?

No

Yes

Bankruptcy?

No

Yes

Who Are You Contracted With?

Employment

Employer Name

Employer Address

Street Address Address Line 2 City State ZIP Code

Employer Phone

Occupation

Employment Status(Required)

Employed here for how long?

How often are you paid?

How much per paycheck?

Other Income

Down Payment

Down Payment Amount

Additional Comments

Consent(Required)

I agree

I agree that by submitting this application, I authorize and give Hodges Westside Truck Center my consent to obtain my credit report from any credit reporting agency used to complete an investigation of my credit.

Is there a Co-borrower?

No

Yes

Co-borrower Information

Co-borrower Personal

Co-borrower Name(Required)

First Middle Last

Co-borrower Address(Required)

Street Address Address Line 2 City State ZIP Code

Co-borrower Phone(Required)

Co-borrower Email(Required)

Co-borrower Social Security Number(Required)

Co-borrower Birthday(Required)

Co-borrower Mortgage/Rent Payment (per month)(Required)

Co-borrower Residence Type

(Co-borrower) How long have you lived at this address?(Required)

(Co-borrower) If you have lived at your current residence less than 5 years, please enter your prior address

Co-borrower Employment

Co-borrower Employer Name(Required)

Co-borrower Employer Address(Required)

Street Address Address Line 2 City State ZIP Code

Co-borrower Business Phone(Required)

Co-borrower Occupation(Required)

Co-borrower Employment Status(Required)

(Co-borrower) Employed here for how long?(Required)

(Co-borrower) How often are you paid?

(Co-borrower) How much per paycheck?

(Co-borrower) Other Income

(Co-borrower) Consent(Required)

I agree

I agree that by submitting this application, I authorize and give Hodges Westside Truck Center my consent to obtain my credit report from any credit reporting agency used to complete an investigation of my credit.

Phone

This field is for validation purposes and should be left unchanged.

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Location
11201 S. Grant Hwy
Marengo, IL 60152

Phone 815-923-0100
Fax 815-923-0101
Used Parts 224-747-2007

Monday – Friday
8:00 am – 5:00 pm

Saturday
8:00 am – 1:00 pm

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