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Please enable JavaScript in your browser to complete this form.
SECTION 1: BUSINESS APPLICANT
COMPANY INFORMATION
Business Type
*
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Other
State of Formation
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OR
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Date of Entity Formation
*
Federal Tax ID
*
Industry
*
Business Name
*
Previous Company Names or DBA's
Owner/GM Contact
*
Phone
*
Email
*
Purchasing Contact
*
Phone
*
Email
*
Maintenance Contact
*
Phone
*
Email
*
AP Contact
*
Phone
*
Email
*
Business Phone Number
*
Street Address
*
City
*
State
*
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AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
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ND
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OK
OR
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RI
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SD
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TX
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VT
VA
WA
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Zip
*
Billing Phone Number
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Billing Address
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City
*
State
*
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AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip
*
Years In Business
*
Trading
*
Public
Private
N/A
Tax Exempt Status
*
Yes
No
Upload your tax exempt certificate: (3 MB limit, JPG, PDF, or JPEG files accepted)
Click or drag a file to this area to upload.
SECTION 2: CREDIT REFERENCES
Business Name
*
Previous Company Names or DBA's
Bank
*
Loan Officer
*
Credit References
Name & Relationship
*
Phone
*
Name & Relationship
*
Phone
*
Name & Relationship
*
Phone
*
SECTION 3: EQUIPMENT LOCATION
Equipment Location Phone
*
Equipment Address
*
City
*
State
*
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AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code
*
SECTION 4: INSURANCE FOR EQUIPMENT
Name of Insurance Company
*
Contact
*
Phone
*
Policy No.
*
Expiration
*
Self-Insured
*
Yes
No
Self-Insured Details
FAIR CREDIT REPORTING ACT (FCRA DISCLOSURE)
If the undersigned is an individual or sole proprietor: This application for credit will be submitted to Toyota Motor Credit Corporation ("TMCC") at 19001 S. Western Ave, Torrance, CA 90501 for consideration as to whether it meets purchase requirements.
SIGNATURE
The undersigned agrees, represents and warrants as follows with respect to themselves alone and with respect to the information related to themselves alone. This completed form is furnished to TMCC in connection with an application for financing a business purchase or lease of commercial use equipment or vehicle(s) and TMCC will rely on the information furnished in connection with this application in making its decision. The undersigned represents and warrants that all information contained in the above application and in all financial statements or other information provided to TMCC in connection with this application, is complete, true and correct, and accurately represents the financial condition of the undersigned. The undersigned has no knowledge of any liabilities, contingent or otherwise, not reflected in this application or any of the financial statements provided to TMCC in connection with this application. Since the date of the most recent financial statements furnished to TMCC in connection with this application, there have been no materially adverse changes in the financial condition of the subject of the statements. If the undersigned is an individual or sole proprietor, the undersigned further agrees as follows: I authorize TMCC to investigate my credit and employment history and to obtain a consumer credit report on me from one or more credit reporting agencies. If credit is granted, I authorize TMCC to obtain subsequent consumer credit reports on me in connection with any update, renewal or extension of credit, collection of the account, or other legitimate business purposes associated with the account, and to release information about its credit experience with me to others as permitted by law.
Business Applicant Name
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Signature Date
*
Applicants Title
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Signature
*
Clear Signature
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