Credit Application

Please fill out (type in) the below information and we'll get started on helping you to get that preferred pre-owned vehicle you have been looking for.

Tell us about yourself - You must completely fill out this form

First Name: Middle Initial:
Last Name:
Address:
City: State:
Zip Code:

 Cell Phone or Pager:

Email: Home Phone:
Social Security Number: Date of Birth:
Age:   Married, Divorced or Single:
Drivers License Number: State:
Name of Bank, Representative & Phone Number:
Insurance Company, Agent & Phone Number:
Landlord or Mortgage Company, Representative & Phone Number:
Monthly Payment:   Rent, Own or Buying:
How Long at this Address:   
Previous Address, if above address is less than five (5) years:
(with city, state, zip & phone number of landlord)
What Utilities are in your name:
List any supplemental income (stocks, child support, tips, etc.):
Have you declared bankruptcy in the past 10 years.  If so, give details:
Are you a previous customer of ours.  If so, give details:
Nearest relative not living with me:
(name, address, city, state, zip, phone number & relationship)
List a minimum of three (3) personal references:
(name, address, city, state, zip, phone number & relationship)

Employment Information:

Employer: How Long:
Supervisor:
Address:
City: State:
Zip Code: Work/Business Phone:
Occupation
(Position):
Salary
(After Taxes):
You are Paid:
Previous Employer if current employer is less than three (3) years:

Vehicle You Are Requesting Financing For:

Make:
Model:
Year: Our Stock Number, if known:

Financing Options:

Type of Credit you are applying for:
1. Individual Credit - Applying for credit in your own name and relying on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested.
2. Joint Credit - Applying for joint credit with another person.
*  If you selected "JOINT" from above, please fill out the following co-applicant information:
First Name: Middle Initial:
Last Name:
Social Security Number: Date of Birth:
3. Individual Credit - Applying for credit in your own name but relying on additional income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested.
             Amount of the Your Down Payment: 
  Term of the Financing You Are Requesting:  
Maximum Monthly Payment You Can afford: 

Authorization:

I authorize the above named merchant to investigate my credit history, obtain information from others concerning my credit standing, and other relevant information impacting on this application.  I hereby certify, and represent that all the above information is accurate and complete, and that I am competent to enter into contracts.
       
  YES      No                                  Date:
Applicants Signature:
                                                                             
How did you hear about us:

When Completed, Please Print it Out, then Fax It to Us.

317.353.6068