Applying For Lease/Finance
Working Capital
Both

Step 1: Company Information
Step 2: Customer Information
Step 3: Equipment Information

Step 1: Company Information
New Company
Existing Company

Legal Company Name
Operating Name (DBA)
Business Type
In Business Since
Physical Address
City
State
ZIP Code
County
Business Phone Ext.
Business Fax
Website
Average Annual Revenue
Average Bank Balance
Federal Tax ID
Do you own a truck?
No
Yes
Number of Trucks Owned
Are you tax exempt?
No
Yes
Tax Exempt Number

Step 3: Equipment Information
Equipment Description
Estimated Equipment Cost
Equipment Status
New
Used
Equipment Titled
Yes
No
Equipment Year
Working Capital Amount
Budgeted Monthly Payment
Time Frame
Initial Payment Available
Comments
Please note that you will be able to upload any attachments you wish to include after the initial submission.
By checking this box, I agree with the Terms of Use and Privacy Policy.
I authorize Highway Commercial Services, Inc. (“HCS”) and any finance company, bank, or other financial institution to HCS submits my application to investigate my credit and employment history (if an individual), obtain credit reports, contact any of my current or former creditors to verify any information contained herein or received in connection with this Authorization or the accompanying credit application which You deem relevant to the possible extension of credit to me (“Information”), and release Information about Your credit experience with me as the law permits. I authorize HCS to disclose Information to any affiliate, assigns or agent. If an account is created, I authorize HCS to obtain credit reports for the purpose of reviewing or taking collection action on the account, or for other legitimate purposes associated with the account. If I am an individual, I authorize the release of federal and state records of my employment and income history. If required by the transaction, I authorize HCS to file a UCC Financing Statement. I consent and agree that HCS, and any successors, affiliates, agents or service providers may to the extent permitted by law; (i) monitor and record telephone calls concerning my account to assure quality of service or for other reasons; and (ii) use written, verbal, and electronic means to contact me, including, without limitation, manual calling methods, prerecorded or artificial voice messages, text messages, e-mails and/or automatic dialing systems. Such means of contact may include use of an e-mail address or any telephone number I provide, now or in the future, including a cellular phone or other wireless device number, regardless of whether I incur charges as a result.

Thank you for submitting your application. We look forward to working with you. Please expect a sales executive to contact you shortly.
Lease Reference Number:
Working Capital Reference Number:
Attachments
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For questions about financing, contact: Nicole Snyder Phone: 8854 Email: nsnyder@highwaycommercial.com

For all other inquiries, contact: Lara Foster Phone: Email:

Step 1: Company Information

Step 2: Customer Information

Principal 1

Principal 2

Principal 3

Principal 4

Principal 5

Principal 6

Step 3: Equipment Information

Attachments