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Truck Questionnaire

Name of Business:


Please enter your Name of Business
Contact Name:

Required: Please enter your last name
Contact Title:

Required: Please enter your Contact Title
Business Address:
City:
State:
Zip Code:
Business Phone:
Business Fax:

Please enter your valid Business Fax
Contact Email:

Please enter your valid email address
Type of Business:
Please give a brief description of the intended use and
operation of the vehicle:
Where will the truck be domiciled?
How many miles per year will it be driven?
How far from "home" will it go? (Radius of Operation)
Will it be driven across state lines?
What percent of the time will it be on highways?
What percent of time will it be on city streets?
Give a brief but precise description of the payload (cargo carried, maximum weight carried/percentage of time, average weight carried/percentage of time, how it is loaded on the truck, how it is packaged and shipped, diminishing load, tie-down requirements).
Please tell us about any special equipment needs or other fleet related issues:
How would you like us to contact you?:

We understand that I/We may submit my application to Madison Capital, LLC electronically by clicking "Submit Application" below, or I/We may submit the application by fax or mail. We authorize Madison Capital LLC to make such inquiries regarding the information furnished herein as may be required in connection with the application, or in the course of review of any credit extended in reliance on the application, such as obtaining individual credit bureau reports, Dun & Bradstreet business reports, and/or other credit reports/references. I/We represent that all information set forth in this application is a truthful and accurate representation of facts for the purpose of obtaining the lease financing requested by me/us. If I/We choose to submit this application electronically, I/We acknowledge that Madison Capital LLC is unable to ensure that the data cannot be intercepted by third parties. In submitting this application electronically I/We knowingly and voluntarily agree that Madison Capital LLC will not be held liable in any manner whatsoever should such interception occur. I/we understand that other financial information may be requested in connection with this lease application, and that this application is not an offer to extend credit.
I agree and accept the above.

“I have been very pleased with how quick and knowledgeable your staff has handled the details of each lease. We are currently in the planning stages to open a third learning center and the services of [Madison Capital] have been an important element in the decision to proceed.”

Roger Shore, M.A.,
Executive Director Sylvan Learning Center

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