ONLINE APPLICATION

TRUFCO FOR CARS

Applicant Information

First Name*

Email address*

City*

Previous Address*

(if less than 2 years at current)

How long have you been driving the truck you are driving now?

Please provide 5 companies you have worked with!

Middle Name*

Phone No*

Address*

Province*

Is truck driving your main source of income?

Yes

When was the last time the vehicle was inspected by a mechanic?

Last Name*

Other No

Length of residence in current home*

Postal Code*

How long have you been driving trucks?

What is the main route you drive? From where to where?

Co-Applicant Information

First Name*

Email address*

City*

Previous Address*

(if less than 2 years at current)

Middle Name*

Phone No*

Address*

Province*

Last Name*

Other No*

Length of residence in current home*

Postal Code*

Repairer (“Assignor”)

Repairer Name*

Address*

Invoice #*

Repair Amount*

Vehicle Description (the “Vehicle”)

Year*

Odometer Reading*

License Plate*

Make*

Vehicle Color*

Insurance Company*

Model*

Vehicle Identification Number (V.I.N.)*

Policy Number*

I Agree*

I, the undersigned, consent to the collection and use of my personal information by TRUFCO and/or its third-party service providers in respect of a repair loan. By applying, I agree to TRUFCO’s Wireless Policy, Privacy Policy and Terms & Conditions outlined in the repair loan agreement and on TRUFCO’s website. I further acknowledge that I must receive authorization from TRUFCO for all work/repair performed by the repairer. I am fully responsible for payment of any repairs until I sign a contract for a repair loan with TRUFCO. I certify that the information on this form is true and complete and that the information on this form shall supersede information previously provided. I understand that if I knowingly make a false statement or misrepresentation in the application or other document or willfully provide any false or misleading information, I plead guilty of offence and accept full liability for a fine or summary conviction.

This field should be left blank

ONLINE APPLICATION

TRUFCO FOR CARS

Applicant Information

Co-Applicant Information

Repairer (“Assignor”)

Vehicle Description (the “Vehicle”)

Miscellaneous

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