Complete application

KingPin Leasing LLC
Trailer Leasing Application

Please fill out the form below or download the pdf form and email us at gmail.com

Business Name and DBA (if any) Email

Address

Street Address City ZIP / Postal Code

Mobile Number

Fax Number

Office Numbe

State of Registration

Date Established

Federal Tax ID

MC Authority #

Business Type

C Corp

S Corp

LLC

Partnership

Sole Prop

State Organizational ID

# Company Trucks

# Owner Operators

Current Factoring Company

OTHER INFORMATION

COMPANY OWNER(S)

Full Name

Title

Social Security Number

% of Ownership

Address

Street Address City State / Province / Region ZIP / Postal Code

Drivers License Number

State Issued

Expiration

DOB

References

Reference 1 - Full Name

Phone #

Reference 2 - Full Name

Phone#

Reference 3 - Full Name

Phone#

Driver License Number

State Issued

Expiration

DOB

Special Notes & Insurance Instructions

By executing this application, the undersigned person(s) certifies to the following: That he/she is an authorized representative of the company and has authority to complete the application on behalf of the company. He/She authorizes KingPin Leasing LLC to run a background check. Requirements for lease: 1. Copy of front and back of drivers license of owner and driver (if different) 2. Copy of current utility 3. Must provide insurance certificate with KingPin Leasing LLC as the loss payee and additional insured. KingPin Leasing operations to provide VIN# and trailer # to include with your insurance request.

MUST BE SIGNED BY MAJORITY OWNER(S) OF THE COMPANY

(Please attach additional sheets if necessary)

Signature

Date

Print Name and Title: