Online Rental Application

Use the form below if you have all credit information available and want the speediest processing of your rental application.

If you do not have all of your credit information available, you may use our short form, but this will take longer to process.

Fields with an asterisk * are required. The data on this form is encrypted and submitted on a secure server for your safety. If you need help or have any questions feel free to call us at 541-276-5012 or toll-free at 888-WOODPECKER (966-3732). Ask for Vicki (ext. 343) or Delwyn (ext. 375). Thanks for choosing Woodpecker Truck!

Firm Name:*
Parent Company: (if applicable)
Contact Person:*
Email Address:*
Physical Address:*
City:*	State:* Zip:*
Phone:*	Fax:
Provide EITHER the tax ID or SSN below.
Tax ID: *	Are you taxable? Yes No
SSN:*	Date of Birth:


Billing Address:*	My billing address is the same as above
Billing City:*	State:* Zip:*


Previous Address:
Previous City:	State: Zip:


As applicable, list name(s) and address(es) of corporate officer(s), partner(s), etc.
Corp. Name 1:
Corp. Address 1:
Corp. City 1:	State: Zip:
Corp. Name 2:
Corp. Address 2:
Corp. City 2:	State: Zip:
Type of Business:	Years/Months in Business:


Trade References
Reference 1:*
Address 1:*
City 1:*	State:* Zip:*
Phone:*
Reference 2:*
Address 2:*
City 2:*	State:* Zip:*
Phone:*
Reference 3:*
Address 3:*
City 3:*	State:* Zip:*
Phone:*


Commercial Insurance Agent:*
Phone:*


Type of Equipment:
Farm Trucks: Single Axle Tandem Axle
Type and quantity of beds needed:
Qty: Cab and Chassis Only Qty: End Dump with Hoist
Qty: Flat Bed Only Qty: Self-Unloading Bed
Transmission Type:
How many: Check if you need Automatic Transmission(s)
Dump Trucks:
Two Axle Five Axle Three Axle Hitch w/Hyd. Line Four Axle Hitch w/o Hyd. Line
Cubic Yards:
Water Trucks:
Two Axle Three Axle
Gallons:
Fifth Wheel Tractors:
Two Axle Sleeper On/Off Highway Three Axle Day Cab Hydraulic Wet Kit Four Axle (Lift Axle) On Highway Only Cab Guard
Trailers:
Flatbed Step Deck Belly Dump Side Dump Hopper Bottom End Dump Pup Lowboy Hopper Bottom Train End Dump Semi
Approximate Time Frame:
Start Date: End Date:
Gross combined weight - Tonnage:

Material, product, or commodity to be hauled:

Hauling From:	Hauling To:
Special Requests, Notes, or Comments:
Terms and Conditions Applicant must be at least 18 years of age. Applicant authorizes Woodpecker Truck to consult any creditors or other persons, whether listed on this application or not, and to receive from or give to them any information pertinent to the credit process. The Lessee agrees to pay such money as is actually spent by Woodpecker Truck for collection cost in the event of default of rental due; and in the case of suit or action instituted to collect the rental or any portion thereof, the undersigned Lessee promises to pay all costs of collection, including any reasonable attorney fees. Applicant understands that rentals are to be paid in advance and this does not constitute a request for extension of credit. Please contact our credit department directly at our Pendleton location if you wish to open an account for parts and/or service. By pressing the submit button below I accept and understand the terms and conditions above.

Is this form to long? Don't have all of the requested information?
You may use our short form.

WOODPECKER TRUCK Pendleton, OR · I-84 & Exit 202 · 888-WOODPECKER · CONTACT

Online Rental Application

Terms and Conditions