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CREDIT APPLICATION
DATE OF APPLICATION
BUSINESS INFORMATION
CONTRACT TO BE IN BUSINESS NAME
YES
NO
# OF YEARS IN BUSINESS__________
BUSINESS NAME
20-4866418
DBA
PARTNERSHIP
S CORPORATION
C CORPORATION
LLC
ADDRESS
WORK NUMBER
FAX NUMBER
43085
614-571-2751
614-388-5544
PERSONAL INFORMATION
NAME (FIRST, MIDDLE INITIAL, LAST)
DATE OF BIRTH
278-06-4351
01/12/1973
PHYSICAL ADDRESS
43085
TIME AT ADDRESS
YRS 14
OWN
MOS
RENT
HOME PHONE
PAGER/MOBILE PHONE
E-MAIL ADDRESS
CDL NO.
PAYMENT
YEARS DRIVING YEARS AS OWNER
614-571-2751
goldlinetrucking@yahoo.com
SK647964, OHIO
12
CURRENT EMPLOYER
PHONE NO.
CONTACT NAME
HOW LONG
614-571-2751
NO
NO
NO
NO
IS THIS PURCHASE A:
REPLACEMENT
ADDITION
NUMBER OF TRUCKS
NUMBER OF TRAILERS
CURRENTLY OWNED______
CURRENTLY OWNED_______
CURRENTLY LEASED ______
CURRENTLY LEASED_______
DATE FINANCED
FINANCED BY
PHONE NUMBER
MHC KENWORTH
877-642-8725
05/2012
FINANCED BY
MHC KENWORTHIN
PHONE NUMBER
877-542-8725
DATE FINANCED
06/2012
CH ROBINSON
YES
No
PHONE
CONTACT
COMMODITY HAULED
1-855-229-6128
$26,000
GENERAL FREIGHT
PURCHASER TO DRIVE
YES
New Lease ?
NO
If NO- provide
DRIVERS NAME
MEHAR SINGH
BHULLAR
YES
NO
MOBILE NUMBER
DATE OF BIRTH
YEARS DRIVING
YEARS AS OWNER
ADDRESS
OWN
PAYMENT
NO
RENT
HOW LONG?
YRS
NO
HONE NUMBER
MOS
NO
For the purpose of establishing and maintaining credit, the undersigned submits the foregoing statement and information contained on this sheet, both written and printed, and including supplemental
sheets, if any, as being a full, true and correct statement of my financial condition and all above matters, on the date stated. The undersigned agrees to notify you immediately in writing of any materially
unfavorable change in my financial condition of the above matters, and in the absence of such notice or of a new and full written statement, all matters herein may be considered as a continuing statement
and substantially correct. The undersigned hereby authorizes MHC Financial Services, Inc., its assignees and/or designees to make inquiry into, to request, and to receive any information concerning my
character, general reputation, personal characteristics, mode of living, and all information from creditors which MHC Financial Services, Inc. , its assignees and/or designees deems relevant for the
granting and collection of the proposed borrowing. This authorization shall be effective from the date upon which this application is signed and is extinguished automatically upon full payment of the
present borrowing, if any is granted. Upon my written request, additional information as to the scope of this inquiry, if one is made, will be provided.
I understand that the decision to grant or deny credit will be at the sole discretion of MHC Financial Services, Inc. as determined by the credit department located at 11120 Tomahawk Creek
Parkway Suite 100-A, Leawood, KS 66211.
I further represent that neither the undersigned, any principal officer of the undersigned, nor any contemplated operator of any equipment proposed to be purchased has any record or reputation of having
violated any federal or state laws relating to liquor, narcotics or contraband; and no such person has been convicted of any felony.
___________________________________________________________________________________
SIGNATURE (BUYER)
DATE
__________________________________________________________________________
SIGNATURE (CO-BUYER)
DATE
MHCFS-CREDIT-WI-4.9-12-c 07/13