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ENGLAND CARRIER SERVICES
ECS APPLICATION
> Open Application in a PDF
Legal Business Name
Phone
Assumed Name(s) or DBA(s)
Fax
Address
Date Established
City
State
Zip Code
E-Mail
Type of Business
Corporation
LLC
Partnership
Sole Proprietor
# of Company Trucks
Owner Operator Trucks
MC #
Factored Previously?
Yes
No
If Yes, With Whom
Contract Expiration
Please list all Owners and Upper Management
OFFICER #1:
Officer Name
Title
Social Security #
Address
% Owned
City
State
Zip Code
OFFICER #2:
Officer Name
Title
Social Security #
Address
% Owned
City
State
Zip Code
Are there any unsatisfied judgments, tax liens, or lawsuits against you?
Yes
No
Have all taxes which are due been paid in full?
Yes
No
Have you ever filed bankruptcy or been convicted of a crime?
Yes
No
If you answer yes to any of the above questions please describe.
Please check each of the programs of potential interest to your company.
A/R Factoring (for a free rate quote, complete the section below)
Fuel Discounts
Tire Discounts
Truck/Trailer Sales
Referral Source - How did you hear about these programs? (check all that apply)
England employee/agent - name:
Website
Mailing
Other trucking company
Advertisement - location:
Other:
Applicant and the undersigned individuals certify, represent and warrant that the foregoing information is accurate and complete and does not omit any information necessary to make this Application not misleading. England Carrier Services is authorized to order credit and business reports on Applicant and the undersigned individuals, contact references (whether or not listed on this application) and conduct such other investigation and review as England Carrier Services deems appropriate.
Fleet Name
Officer 1
Title
Fleet Name
Officer 2
Title
ONLY COMPLETE THIS SECTION TO RECEIVE A FREE FACTORING RATE QUOTE
A/R Outstanding Currently
Average Invoice Amount
Approximate # of Customers
Average Monthly Sales
Customer/Broker List (include all companies you intend to factor)
Name #1
MC Number
Phone Number
Current Balance
Name #2
MC Number
Phone Number
Current Balance
Name #3
MC Number
Phone Number
Current Balance
Name #4
MC Number
Phone Number
Current Balance
Name #5
MC Number
Phone Number
Current Balance
Name #6
MC Number
Phone Number
Current Balance
Name #7
MC Number
Phone Number
Current Balance
Name #8
MC Number
Phone Number
Current Balance
Name #9
MC Number
Phone Number
Current Balance
Name #10
MC Number
Phone Number
Current Balance
Applicant and the undersigned individuals certify, represent and warrant that the foregoing information is accurate and complete and does not omit any information necessary to make this Application not misleading. England Carrier Services is authorized to order credit and business reports on Applicant and the undersigned individuals, contact references (whether or not listed on this application) and conduct such other investigation and review as England Carrier Services deems appropriate.
England Carrier Services is authorized to file a UCC Financing Statement against all assets of Applicant upon execution of this Application. If financing is not provided pursuant to this Application, the UCC Financing Statement will be terminated.
Fleet Name
Officer 1
Title
