Jukonski Truck Sales Credit Application

Applicant Information

Current Mailing Address

Physical Address (if different from mailing address)

Additional Information

Employment Information


Current Employer / Haul Reference

Previous Employer / Haul Reference

Previous Employer / Haul Reference

Financial Information

Other Lender Information

I certify the above information is correct to the best of my knowledge.

By typing my name into the field below, the undersigned certifies that the information given above is true and complete and authorizes Jukonski Truck Sales, its subsidiaries and their assigns or potential assigns, or any other lender that this application is submitted to, to investigate the above information and the undersigned's accounts and credit experience. Jukonski Truck Sales credit experience and account information on the undersigned. This shall be a continuing authorization for all present and future disclosures of account information and credit experience on the undersigned by Jukonski Truck Sales, or any person requested to release such information to Jukonski Truck Sales. The undersigned has read and understood the Privacy Policy and the Disclaimer on the website this form was downloaded from.