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Get Individual Purchaser/Lessee Statement

Partnership: Res. Phone: e-mail: Cell Phone: Pager: Used Vehicle Pager ID: Physical Address: City: County: State: Zip: Mailing Address: City: County: State: Zip: APPLICANT INFORMATION: Number of trucks you currently: Operate: Have you ever financed with DCS: Yes No Marital Status: Married Unmarried Date of Birth: Social Security Number: Years As Owner/Operator Separated I am going to operate this vehicle Yes No Years at Present Address Years As Company Driver Total.

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