Name:

E-mail:

Company Name:

Street Address:

City:

   State:   Zip:

Country:

Phone:

  Fax:

Do you presently own or operate a Class 6, 7 or 8 Heavy Duty Truck?

 I own and operate a truck  I operate a truck but don't own it

 I am a purchasing agent who buys trucks for my company

Do you need a: Tractor for 5th Wheel    Truck with body

Under what application is your truck categorized? (Please provide details)

 On-Highway, linehaul with sleeper

 On-Highway, local delivery without sleeper

 Construction (Provide details below, ie: dump, mixer, etc.)

 Refuse/Garbage (Provide details below, ie: rear loader, rolloff, etc.)

 Municipal/Government (Provide details below, ie: snow plow, spreader, etc.)

 Emergency/Specialty (Provide details below, ie: fire pumper, utility truck, etc.)

 Other (Provide details below)

Details:

Please provide the details about your specification requirements:

Engine Horsepower Range: (Please choose one)

 300 H.P. or less   300 to 400 H.P. Over 400 H.P.

Transmission: Manual   Automatic

     Speeds: 5 or less  6 to 10   10 to 15  16 or more

Axle Capacities: Front Axle: pounds

                           Rear Axle: pounds

Do you prefer to buy or lease your vehicles? buy   lease

What brand of truck(s) do you currently own, lease or operate?

 

Mack Freightliner Kenworth Peterbilt  Volvo  Ford

Navistar Sterling Other (Other - please give details below)

(none)

If you own, how many trucks do you own? 

What will be your per-truck price range for your next truck purchase?

 $5,000 - $10,000   $20,000 - $30,000   $50,000 - $75,000

 $10,000 - $20,000  $30,000 - $50,000   Over $75,000