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This is a SECURE online application being submitted to PALMETTO MACHINERY through Fleet Lending Solutions, our finance partner. Please fill-out the application completely and submit. You'll be contacted shortly thereafter.
Fields marked with * are required.

How did you find us or who referred you?

Business Information How is your business setup? Please provide the following details about your entity. Sole proprietorships just use your name as the business name. NOTE: Anything with a red astrick has to be answered with something.
Legal Business Name *
DBA
Business Address* Street Address
City	State / Province / Region
Postal / Zip Code	Country
Year Established (If start-up put this year)*
State Organized In
Organization Type*
EIN
Email
Business Phone Number*
FAX Number
Alternative Phone Number

Principals & Owners Information Please provide the information required of all principale or owners with MORE THAN 20% interest in the company. Principals with MORE than 20% interest
First Name	Last Name
Principal Address* Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country
Date of Birth* MM / DD / YYYY
Phone Number* ### - ### - ####
Email*
Principal 2
First Name	Last Name
Principal Address Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country
Date of Birth MM / DD / YYYY
Phone Number ### - ### - ####
Email
Principal 3
First Name	Last Name
Principal Address Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country
Date of Birth MM / DD / YYYY
Phone Number ### - ### - ####
Email

Banking & Business Who do you do your business banking with & customer references
Banking Institution*
Check All That Apply* Checking Savings
City & State
Phone Number ###-###-####
Contact Name
Additional Banking / Leasing / Lending Institution
Check All That Apply Checking Savings Loan or Lease
City & State
Phone Number ###-###-####
Contact Name
Phone Number ###-###-####
Customer Reference Provide a customer for which for you are doing business or providing services to.
Company*
Contact Name
City & State
Phone Number ###-###-####
Email
Equipment To Be Acquired Description of the equipment and the dealer holding the equipment.
Equipment Description (For ex: 2012 Peterbuilt 387)*

Dealer Name & Contact
Amount $
Phone Number ###-###-####
Email

Current Fleet

Identify the number trucks, trailers and yellow you own and operate

Number of Trucks

Number of Trailers

Number of Pieces of Yellow Iron

In the past 7 years have you or any of the principals had a:*

Bankruptcy - Chapter 7
Bankruptcy - Chapter 13
Home Foreclosure
Vehicle Repossession (Private or Business)
Delinquent Government Loans
Delinquent Child Support
Tax Liens or Judgments not repaid or in repayment
NONE OF THE ABOVE

Enter Explanation for anything checked above:

AUTHORIZATION: By typing my name in the digital signature filed below, I hereby (i) certify that the information provided in this purchase/lease application is true and correct, (ii) authorize Fleet Lending Solutions and any assignee, lending or funding partner that may be involved in the funding process to obtain and verify all credit information provided in this application including bank, personal credit and trade references (iii) understand that my individual credit history will be acquired and may be a factor in the evaluation of the credit worthiness of the applicant, (iv) acknowledge that prior to the disbursement of any funds, Fleet Lending Solutions may re-verify all credit, bank and trade reference information to ensure there has been no deterioration in credit, (v) waive any right or claim I would otherwise have under the Fair Credit Reporting Act in the absence of this continuing consent,(vi) certify that this request is for business and not consumer purposes.

SIGNATURE*

Title*

Date*

Email

For security purposes, please enter the characters from the box above: What's This?

Business Information

Legal Business Name *

DBA

Business Address*

Street Address

City

State / Province / Region

Postal / Zip Code

Country

Year Established (If start-up put this year)*

State Organized In

Organization Type*

EIN

Email

Business Phone Number*

FAX Number

Alternative Phone Number

Principals & Owners Information

Principals with MORE than 20% interest

First Name

Last Name

Principal Address*

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Date of Birth*

MM / DD / YYYY

Phone Number*

### - ### - ####

Email*

Principal 2

First Name

Last Name

Principal Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Date of Birth

MM / DD / YYYY

Phone Number

### - ### - ####

Email

Principal 3

First Name

Last Name

Principal Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Date of Birth

MM / DD / YYYY

Phone Number

### - ### - ####

Email

Banking & Business

Banking Institution*

Check All That Apply*

City & State

Phone Number

###-###-####

Contact Name

Additional Banking / Leasing / Lending Institution

Check All That Apply

City & State

Phone Number

###-###-####

Contact Name

Phone Number

###-###-####

Customer Reference

Company*

Legal
Business Name *