Lewis Capital
480-560-1277
Application for credit under
IndividualPartnershipCorporationLLC
Individual/Guarantor Information
Full Name*
Social Security#
Birth Date*
Address*
City*
State*Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip Code*
Cell Phone*
Home Phone
Business Phone
Email*
RenterHomeowner
Class A
YesNo
Total Years as Owner/Operator*
Total Years of Driving Experience*
US Citizen:
Work PermitPermanent ResidentOther
Comment:
Business/Corporate Information (If applicable)
Name of Company
Federal Tax ID#
State Incorporated
Date of Incorporation
Years in Business
Address
City
StateSelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Zip Code
Guarantor Title
Ownership %
Haul References (Do not put yourself unless you manufacture and deliver your own products)
Haul Name
Haul Phone Number
Haul Contact
Equipment Finance References: (List present or past finance references or designate paid cash)
Finance Company
Phone Number
Collateral (Year, Make, Model)
Approx Balance
Fleet Size
Owned Trucks*
Owned Trailers*
Finances
Bank Name*
CheckingSavings
Balance*
By signing below, each undersigned individual(s), who is either a principal of the credit applicant listed below or a personal guarantor of its obligations, provides written instructions to ARC Capital Solutions, LLC dba Lewis Capital (ARC Capital), its designee, nominees or assignees or potential assignees, authorization to review his or her personal credit profile from a national credit bureau. Authorization is also granted to ARC Capital Solutions, LLC dba Lewis Capital (ARC Capital), its designees, nominees or assignees or potential assignees to obtain business credit reports, bank and trade references, provided to ARC Capital or to its affiliates and to review any provided financial statements. Such authorization shall extend to obtaining a credit profile in considering the application of the credit applicant and subsequently for the purposes of update, renewal, or extension of such credit and for reviewing or collecting the resulting account. A photostatic or facsimile copy of this authorization shall be valid as the original.
Applicant
Name of the Applicant*
Co-Applicant/Guarantor
Name of the Co-Applicant
