If answering "yes" to any of the three items above please explain:
Do you owe/pay Child Support? (*)
If "yes" are you current with your child support obligations? (*)
If answering "no" please explain the situation:
Work History
Primary Work History
First Time Owner Operator?: (*)
Time with employer (Years):
(Mo):
Time as CDL Driver. Yrs: (*)
Mo:
Equipment Owned, if Any, (year, make & model):
New/ Future Carrier: (*)
Phone No:
Contact Name:
OTR, Local or Regional: (*)
Type of Freight: (*)
Reason for Choosing: (*)
Previous Carrier Information #1
Previous Carrier:
Phone No:
Contact Name:
Time with Employer, Yrs:
Mo:
OTR, Local or Regional:
Type of Freight:
Reason for Leaving:
Previous Carrier Information #2
Previous Carrier:
Phone No:
Contact Name:
Time with Employer, Yrs:
Mo:
OTR, Local or Regional:
Type of Freight:
Reason for Leaving:
Finance History
Truck Finance Company:
Dates of Finance:
Phone No:
Truck Information (year, make & model):
Truck Lease Experience
Have you ever participated in another Lease Program? (*)
If "Yes" give date. From:
Until:
Lease program contact name:
Did you complete the program?
Are you currently working with C&C? (*)
I hereby certify that the information contained this application is true and accurate, agree that C&C Truck Sales and Leasing, its affiliates, subsidiaries and/or assigns may obtain, use and rely on for my permissible purpose information compiled by third party vendors for commerical use and sale, including with out limitation that information regarding my financial condition, payment history, employment, assets, motor vehicle driving record and personal history. Furthermore, I hereby authorize my bank(s) trade references, haul source(s), carrier, employers, government entities, and financial institutions to release information to C&C Truck Sales and Leasing, its affiliates, subsidiaries and/or assigns.
