Credit Application - Original Look

Is this to buy or lease?

Buy

Lease

If lease, miles per year:

Trade in:

Down Payment/Trade-In:

Applicant Information

Personal information is used for vehicle loan approval only and not given out for any other purpose.

First Name:

Address:

Middle Name:

Address 2:

Last Name:

City:

Social Security #:

State:

Date of Birth:

Zip:

Email address:

Residence Status:

Rent

Own

Other

Home Phone:

Monthly Rent/Mortgage:

Mobile Phone:

Driver's License Number:

Driver's License State:

Length at Residency yrs:

Length at Residency mos:

Employment Information

Employer:

Employer City:

Employer State:

Gross Monthly Income:

Position:

Other Monthly Income:

Work Phone:

Other Income Source:

Length at Residency yrs:

Length at Residency mos:

Previous Employer

if less than 5 years at current employer

Employer:

Employer City:

Employer State:

Position:

Work Phone:

Length of Employment yrs:

Length of Employment mos:

Other Comments

CUSTOMER ACKNOWLEDGEMENT:

I (we) acknowledge that I (we) received a copy of this notice. The above information is submitted for the purposes of obtaining credit. The undersigned authorizes you to make such inquiries as are necessary to obtain credit information and authorize my bank, suppliers, and credit references to release information regarding my account(s).

I/We certify that everything stated on this credit application is true and correct and that I/we am/are the person(s) on the application and not a misrepresentation.