To: MHC Financial Services, Inc.

CREDIT APPLICATION

11120 Tomahawk Creek Parkway Suite 100-A

Leawood, KS 66211
(816) 483-0441 FAX (816) 483-0916

PLEASE TYPE OR PRINT

DATE OF APPLICATION

BUSINESS INFORMATION
CONTRACT TO BE IN BUSINESS NAME

YES

NO

# OF YEARS IN BUSINESS__________

BUSINESS NAME

BUSINESS TAX ID NUMBER

GOLD LINE TRUCKING LTD

20-4866418

DBA

PARTNERSHIP

PLEASE PROVIDE CHECK IF ATTACHED

LAST 2 YEARS FINANCIALS
CURRENT INTERIM

S CORPORATION

C CORPORATION

LLC

ADDRESS

CITY, STATE, ZIP CODE

WORK NUMBER

FAX NUMBER

1419 Boswall Drive

43085

614-571-2751

614-388-5544

PERSONAL INFORMATION
NAME (FIRST, MIDDLE INITIAL, LAST)

SOCIAL SECURITY NUMBER

DATE OF BIRTH

MEHAR SINGH BHULLAR

278-06-4351

01/12/1973

PHYSICAL ADDRESS

CITY, STATE, ZIP CODE

1419 Boswall Drive

43085

TIME AT ADDRESS
YRS 14

OWN

MOS

RENT

HOME PHONE

PAGER/MOBILE PHONE

E-MAIL ADDRESS

CDL NO.

PAYMENT
YEARS DRIVING YEARS AS OWNER

614-571-2751

goldlinetrucking@yahoo.com

SK647964, OHIO

12

CURRENT EMPLOYER

PHONE NO.

CONTACT NAME

HOW LONG

GOLD LINE TRUCKING LTD

614-571-2751

MEHAR SINGH BHULLAR

HAVE YOU EVER FILED BANKRUPTCY

NO

ARE YOU A DEFENDANT IN ANY LEGAL ACTION:

YES EXPLAIN BELOW

NO

HAVE YOU EVER HAD ANY ITEM REPOSSESSED:

YES EXPLAIN BELOW

NO

YES EXPLAIN BELOW

PRIOR TRUCK AND TRAILER PURCHASES

HAVE YOU EVER FINANCED A TRUCK/TRAILER

NO

IS THIS PURCHASE A:

YES PLEASE LIST BELOW

REPLACEMENT

ADDITION

NUMBER OF TRUCKS
NUMBER OF TRAILERS
CURRENTLY OWNED______
CURRENTLY OWNED_______
CURRENTLY LEASED ______
CURRENTLY LEASED_______
DATE FINANCED

YEAR, MAKE, MODEL

FINANCED BY

PHONE NUMBER

2007, KENWORTH, T600

MHC KENWORTH

877-642-8725

05/2012

YEAR, MAKE, MODEL

FINANCED BY

MHC KENWORTHIN

PHONE NUMBER
877-542-8725

DATE FINANCED

2007, KENWORTH, T600

06/2012

HAULING REFERENCE/MAJOR CUSTOMER

TRUCK TO WORK FOR (PRIMARY REVENUE SOURCE)

CH ROBINSON

YES

No

14701 CHARLSON ROAD EDEN PRARIE, MN 55347

How long with company___yrs ___mos

PHONE

CONTACT

MONTHLY GROSS INCOME

COMMODITY HAULED

1-855-229-6128

$26,000

GENERAL FREIGHT

PURCHASER TO DRIVE

YES

New Lease ?

ADDRESS (INCLUDING CITY, STATE, ZIP CODE)

NO

If NO- provide

DRIVERS NAME

ADDRESS (INCLUDING CITY, STATE, ZIP CODE)

MEHAR SINGH
BHULLAR

1419 BOSWALL DRIVE

OFF HIGHWAY USE

YES

NO

MOBILE NUMBER

COMPLETE THE FOLLOWING SECTION ONLY IF THIS IS A JOINT APPLICATION,

CO-BUYERS NAME (FIRST, MIDDLE INITIAL, LAST)

SOCIAL SECURITY NUMBER

DATE OF BIRTH

YEARS DRIVING

YEARS AS OWNER

ADDRESS

OWN

PAYMENT

HAVE YOU EVER FILED BANKRUPTCY

NO

RENT

YES EXPLAIN BELOW

HOW LONG?
YRS

ARE YOU A DEFENDANT IN ANY LEGAL ACTION:

NO

YES EXPLAIN BELOW

HONE NUMBER
MOS

HAVE YOU EVER HAD ANY ITEM REPOSSESSED:

NO

YES EXPLAIN BELOW

For the purpose of establishing and maintaining credit, the undersigned submits the foregoing statement and information contained on this sheet, both written and printed, and including supplemental
sheets, if any, as being a full, true and correct statement of my financial condition and all above matters, on the date stated. The undersigned agrees to notify you immediately in writing of any materially
unfavorable change in my financial condition of the above matters, and in the absence of such notice or of a new and full written statement, all matters herein may be considered as a continuing statement
and substantially correct. The undersigned hereby authorizes MHC Financial Services, Inc., its assignees and/or designees to make inquiry into, to request, and to receive any information concerning my
character, general reputation, personal characteristics, mode of living, and all information from creditors which MHC Financial Services, Inc. , its assignees and/or designees deems relevant for the
granting and collection of the proposed borrowing. This authorization shall be effective from the date upon which this application is signed and is extinguished automatically upon full payment of the
present borrowing, if any is granted. Upon my written request, additional information as to the scope of this inquiry, if one is made, will be provided.
I understand that the decision to grant or deny credit will be at the sole discretion of MHC Financial Services, Inc. as determined by the credit department located at 11120 Tomahawk Creek
Parkway Suite 100-A, Leawood, KS 66211.
I further represent that neither the undersigned, any principal officer of the undersigned, nor any contemplated operator of any equipment proposed to be purchased has any record or reputation of having
violated any federal or state laws relating to liquor, narcotics or contraband; and no such person has been convicted of any felony.
___________________________________________________________________________________
SIGNATURE (BUYER)
DATE

__________________________________________________________________________
SIGNATURE (CO-BUYER)
DATE

MHCFS-CREDIT-WI-4.9-12-c 07/13