Form To Complete With Your Lender If You Want A Car Loan
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1FORM TO COMPLETE WITH YOUR LENDER IF YOU WANT A CAR LOAN
(Note: The trustee cannot pre-approve a car loan. This form must be completed first.)
Part “A” (To be completed by the applicant)
Name: _____________________________________ Daytime Phone No.: _______________________
Reason for Car Loan: ____________________________________________________________________
______________________________________________________________________________________
What do you intend do with the car you presently drive? ________________________________________
______________________________________________________________________________________
STOP! If you intend to trade-in a car, you must obtain an order signed by the Bankruptcy Judge before
you go any further! Your attorney will need to review this matter with you.
Are you current on ALL rent or house payments that have come due since you filed your Chapter 13?
Yes __________________ No__________________ If no, how many are you behind? _______________
Part “B” (To be completed by applicant and lender)
No loans approved above 18% interest and payment cannot exceed $350.00 per month.
Name of Lender: _______________________________________________________________________
Make, Model, and Year of Car to be purchased: _______________________________________________
Sales Price of Car: $________________
If used, list NADA value here: $_______________________
Down Payment: $______________________ Source of funds for down payment: ___________________
Amount to be financed: $________________ Total Monthly Payment: $______________________
Annual Interest Rate: ___________________ Term of Loan: __________________________________
You must attach a Buyer’s Order to this portion of the application. Assure that the copy is one that can be
retained by the Trustee. Copies cannot be made for the applicant.
I certify the information contained in Part “B” is true and correct.
______________________________________________Phone Number:______________________
Signature of Loan Officer, Lending Agent or Salesperson
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