Credit Application
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1CREDIT APPLICATION
APP #
(A)
APPLICANT INFORMATION
(B)
JOINT APPLICANT INFORMATION
PRINT FULL NAME
PRINT FULL NAME
DOB
SSN
# OF DEPENDENTS
DOB
SSN
# OF DEPENDENTS
STREET ADDRESS
STREET ADDRESS
CITY
STATE
ZIPCODE
CITY
STATE
ZIPCODE
HOW LONG?
HOME PHONE
CELL PHONE
HOW LONG?
HOME PHONE
CELL PHONE
RESIDENTIAL STATUS
MONTHLY RENT/MORTGAGE PMT
RESIDENTIAL STATUS
MONTHLY RENT/MORTGAGE PMT
LANDLORD OR MORTGAGE HOLDER’S NAME
LANDLORD OR MORTGAGE HOLDER’S NAME
PREVIOUS ADDRESS (if less than 2 yrs at current address)
PREVIOUS ADDRESS (if less than 2 yrs at current address)
CURRENT EMPLOYER’S NAME
CURRENT EMPLOYER’S NAME
CURRENT EMPLOYER’S ADDRESS
CURRENT EMPLOYER’S ADDRESS
GROSS MONTHLY SALARY
WORK PHONE
GROSS MONTHLY SALARY
WORK PHONE
OCCUPATION/JOB TITLE
HOW LONG?
OCCUPATION/JOB TITLE
HOW LONG?
PREVIOUS EMPLOYER (if less than 2 yrs on current job)
HOW LONG?
PREVIOUS EMPLOYER (if less than 2 yrs on current job)
HOW LONG?
OTHER INCOME NOTE: Alimony, child support, or separate maintenance incomes do not have to be revealed unless the applicant wishes to have
such sources considered as a basis for repayment of the requested credit amount.
GROSS MONTHLY OTHER INCOME
OTHER INCOME SOURCE
GROSS MONTHLY OTHER INCOME
OTHER INCOME SOURCE
REFERENCE 1
PHONE
ADDRESS
RELATIONSHIP
REFERENCE 2
PHONE
ADDRESS
RELATIONSHIP
FAIR CREDIT REPORTING ACT TO CONSUMER
THIS WILL ADIVSE YOU THAT YOUR RETAIL INSTALLMENT SALES CONTRACT AND BUYER’S APPLICATION FOR SECURED DEBT WILL BE SUBMITTED TO FINANCIAL
INSTITUTIONS AND THEIR AFFILIATES FOR PURCHASE AND CONSIDERATION AS TO WHETHER YOU MEET THEIR CREDIT REQUIREMENTS.
THE UNDERSIGNED FURTHER AUTORIZES THESE FINANCIAL INSTITUTIONS AND THEIR AFFILIATES TO OBTAIN SUCH INFORMATION THAT THEY MAY REQUIRE IN
ORDER TO VERIFY INFORMATION RELATIVE TO THIS REQUEST INCLUDING CONTACTING SPOUSES TO VERIFY SPOUSE RELATED INFORMATION.
I CERTIFY THAT ALL INFORMATION GIVEN BY ME ON THIS APPLICATION IS COMPLETE AND ACCURATE. I GIVE MY PERMISSION FOR ANY FINANCIAL INSTITUTION
WHICH WILL REVIEW THIS CREIDT APPLICATION, TO INVESTIGATE MY CREDIT AND EMPLOYMENT HISTORY, AND TO ANSWER QUESTIONS ABOUT THEIR CREDIT
EXPERIENCE WITH ME INCLUDING BUT NOT LIMITED TO LATE PAYMENTS, MISSED PAYMENTS OR OTHER DEFAULTS, AND THIS INFORMATION MAY BY REPORTED
IN YOUR CREIDIT REPORT.
APPLICANT
JOINT APPLICANT
SIGNATURE _______________________________________________
SIGNATURE _______________________________________________
REQUIRED
DATE
REQUIRED
DATE
(means you intend to apply for joint credit)
(A) APPLICANT Driver’s License No. ____________________________
(B) JOINT APPLICANT Driver’s License No. ______________________
FOR DEALER USE ONLY
NEW
USED
DEMO
YEAR
MAKE
BOOK VALUE
CASH SELLING PRICE
___________
NET TRADE
___________
MODEL
BODY STYLE
MILEAGE
CASH DOWN
___________
UNPAID BALANCE
___________
TRADE IN YEAR
MAKE
MODEL
LIENHOLDER
PLUS INSURANCE & FEES
___________
TOTAL AMOUNT FINANCED
___________
TERM
RATE
AMOUNT
DEALER (UNDERWRITER)
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Parent category: Business