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.
