Leasing & Rental Request A Quote Leasing/Rental Request A Quote HiddenNext Steps: Sync an Email Add-OnTo get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page: (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020). Important: Delete this tip before you publish the form.Name(Required) First Last Email(Required) Enter Email Confirm Email PhoneFull Business Name Incorporation Date(Required) EIN (FED TAX ID)(Required) Incorporation Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code How many trucks do you operate?(Required) 1-3 3-5 5-10 10+ Are you looking to lease or rent?(Required) Lease Rent Desired Equipment?(Required) Dump Truck Daycab Sleeper Roll Off Truck Box Truck How long are you needing this equipment? Terms(Required) I acknowledge & agree to the terms. I do not agree to the terms. I HEREBY AGREE THAT PAYMENT IN FULL WILL BE MADE WITHIN NET SEVEN (7) DAYS FROM THE DATE OF THE CHARGE. I FURTHER AGREE THAT ALL CHARGES NOT PAID WITHIN THIRTY (30) DAYS THEREFROM WILL BEAR INTEREST AT THE RATE OF 1 1/2% PER MONTH (18% PER YEAR) UNTIL PAID. I FURTHER AGREE TO PAY ALL COSTS OF COLLECTION INCURRED BY PACCAR LEASING COMPANY, INCLUDING REASONABLE ATTORNEY’S FEES. I HEREBY CERTIFY THE INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE A REPRESENTATIVE TO CONTACT ANY OR ALL OF THE ABOVE BANKS OR REFERENCES TO VERIFY THE CORRECTNESS OF THE APPLICATION. I AM DULY AUTHORIZED TO ENTER INTO THIS AGREEMENT AND TO OPEN THE ACCOUNT. *ALL QUOTES ARE SUBJECT TO CREDIT APPROVAL*Digital Signature(Required) CAPTCHA Δ
