Oskar Ex Inc

General information

First Name*

Last Name*

Date of birth

Select your sex Male Female

Address information

Street Name*

City/State*

Zip Code*

Are you citizen of the United States? Yes No

Contact information

Phone Number*

E-mail*

Company Name*

Emergency contact

Full name

Relationship

Phone

Emergency Number*

Address

Bank Information

Name on the account

Type

Routina#

Account#

Drivers licence Information

Drivers License number*

State*

Social Security Number*

Tax Id*

DL Issue date*

Expiration date*

Class*

Endorsements*

Card

Name

Truck

Last 5 of the vin#

Plates

Ipass

Documents

Upload pictures of Driver’s license

Upload social security

Upload W-9

Upload bank information

Upload green card

Other

Information provided by you must be to TRUE the best of your knowledge. We reserve right to terminate your contract if we find out that you have provided false information on this application.

By selecting the “I Accept” button, you are signing this Agreement electronically.

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Thank you for your request

We look forward working with you!

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