Fax:
Credit Application 		Phone:
 
Primary Appplicant
Yes______ No_____ 		Joint Applicant:_____Joint Credit with Primary Applicant, Or Guarantor
Primary Applicant:_____Relying on other income, Child Support, etc.
Joint Applicants
Relationship: 		______Married
______Parents
______Both
 
Last Name First Name Middle Name
     
# of Dependants
__________ 		Date of Birth
_____/_____/_______		 Age
______
 
Current Address ( Number and Street) City State Zip Code
 
 
Applicants Home Phone #
(______) ______ - _________ 		Applicants Cell Phone #
(______) ______ - _________ 		Own Home:______
Renting:______
Buying Home:______ 		Time at Present Address:
_____ Yrs. _____ Mos. 		Drivers License # and State:
_________________________
 
 
Previous Address (Street, City, State, Zip Code) If less than 2 years at present: Length at Address:
  _____ Yrs. _____ Mos.
 
Current Employer: Employers Address: City and State Telephone # with area code
    (______) ______ - _________
 
Present Occupation: Time on Job: Employers Telephone #: Gross Pay Amount:
Weekly:__________ Monthly:________ Bi-Weekly:________
  _____ Yrs. _____ Mos. (______) ______ - _________
 
Social Security Number: Other Income: $________________ Other Source of Income:
______-_____-________ Weekly:__________ Monthly:__________ Bi-Weekly:__________
 
Previous Employer (If less than five years) City State Zip Code Time at this job:
        _____ Yrs. _____ Mos.
 
Name of your Bank: Address: City: State: Checking: Savings: No/Yes Account:
        $__________ $__________ __________
 
Ever had repossession ? If Yes, Where? (City, State) Month/Year Ever filed bankruptcy?
Yes______ No______   ______/______ Yes______ No______ Where___________________ Year_______
 
Applicant is making Alimony, Child Support, or Spousal Support Payments? ______ Yes ______ No Amount Paid: $_______________________
 
Creditor' Name City/State Date Opened Monthly Amount Unpaid Balance Account Current
      $____________ $____________  
      $____________ $_____________  
 
Name and Address of Applicant(s) nearest relative or friend not living with applicant Telephone number Relationship to Applicant
  (______) ______ - _________  
  (______) ______ - _________  

For the purpose of securing credit from you, I certify that the above information is true and complete to the best of my knowledge. I further certify that I have attended the Age of majority. I authorize you to check my credit and employment history, and will provide any and all information needed regarding my credit experience.

Signature_________________________________________________________ Date_______________________

For Seller, Dealer and Office Use Only
Cash Price Including Tax and License $________________
   
Down Payment (Cash) Amount $________________
   
Less Trade-in Allowance (-) $________________
   
Total Amount Financed $________________
Vehicle Information:
Year:_______ Make:___________ Model:_________________ Mileage:_____________
Options:_____________________________________________________________
 
Trade-In Information:
Year:_______ Make:___________ Model:_________________ Mileage:_____________
Options:_____________________________________________________________