Long-Lewis Sterling
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Customer: 
Address:  
Tax ID#: 		 Date: 
Contact: 
Title: 
Phone: 

Corporate Tax Structure:   "C" Corp    "S" Corp     LLC     Partnership

Years in Business:  

Officers/Key Managers:

Name/Title
Social Security #
Stock Ownership %
Years with Co.
Years Experience



Type of Carrier:   LTL    Truckload     Private     Hazardous Cargo

Top Five Customers:




 Principal Freight Type:




 Annual Rev.:




 % Revenue





Receivables Aging:
 %
0-29 Days		  %
30-59 Days		  %
60-89 Days		  %
90+ Days

Fleet Make-Up:

Tractors:

Trucks:

Trailers:		 # Financed



 #Leased (Capitalized)


 # Leased (Operating)


 # Units Owned (F&C)


 Total Units





Typical Trade Cycle (months)
Average Age (years)		 Tractors:

 Trucks:

 Trailers:


Drivers:
Average Company Driver Turnover (annual)    %
Number Owner Operators Used 
Number Driver Teams     Company Teams      Independent Teams
Annual Mileage      Single Driver      Team Drivers

Terminals:
Number of Terminals       Leased      Owned  
Locations

Creditor Information:
Company




 Phone # & Contact




 Account #




 Equip. Financed





Bank Information
Name


 Phone # & Contact


 Account #



Type:

Physical Damage
Liability
Workers Comp.		 Deductible



 Limit



 SIR



 Self Insured? (Y/N)


 Reserve Balance


 Monthly
Res. Amt.



Do you lease equipment between related entities or to other end users?    Yes     No
If yes, please provide a copy of the lease agreement(s) and schedule(s).

Current Transaction:   Number of units to be purchased/leased 
Number of trades or disposals 

Please provide three years financial statements and the most current interim statement with a prior period comparison.

AUTHORIZATION TO RELEASE CREDIT INFORMATION

The undersigned hereby authorizes the making of inquiries into, request for, and receiving of any information concerning my general reputation, and all information from creditors which is deemed relevant for the potential granting of the proposed borrowing. This authorization shall be effective from the date upon which this agreement is signed and is extinguished automatically upon full payment of the present borrowing, if granted.

Company Name:

By:

Title:
  Date: 

Either submit via e-mail, or print form and mail to:

Long-Lewis Sterling
Attn: F&I Division
P.O. Box 989
Bessemer, AL 35021

  

Sterling New Trucks Sterling Fleet Sales Sterling Lease Programs Finance Department
Service Department Parts Department Long-Lewis Sterling Locations Employment Opportunities About Long-Lewis Sterling
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