Leasing & Rental Request A Quote Leasing/Rental Credit Application 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 Phone Number(Required) Business Name(Required) Full Business Name Mr.Mrs.MissMs.Dr.Prof.Rev. 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