Consumer Credit Application Form

This form requires a signature. After submitting this form, you will be directed to a printable page. You must print and sign that page. Once the form is signed, you can mail or fax the form to us, or you may deliver it to our location.

Are you a partnership or corporation? Please select an item.

How you are applying for credit?	Please select an item.	If you are applying as an individual, but you are relying on income from alimony, child support, separate maintenenace on or the income or assets of another person as the basis of repayment of the child requested, you must choose "Joint w/Other."
Type of Application	Please select an item.	Dealership Name	A value is required.

Applicant Info

First Name	A value is required.		Last Name		A value is required.
MI	Nbr. in Family	A value is required.	Social Security Number		A value is required.Invalid format.
Street Address	A value is required.		City		A value is required.
State	Please select an item.		Zip Code	A value is required.	Phone	A value is required.Invalid format.
Email	Invalid format.				Date of Birth A value is required.Invalid format.
Marital Status	Please select an item.		U.S. Citizen?		Please select an item.
Drivers License Number A value is required.			Drivers License State		Please select an item.
Drivers License Exp. Date A value is required.

Housing Info
Housing Status Please select an item.	Rent per Month ($)	How Long at Current Address (years/mo)? A value is required.
Current Mailing Address (if different)		Previous Address (if less than 2 years)
Number of Years (at previous address)		Mortgage Company/Landlord
Mortgage Balance	$	Market Value	$
Nearest Relative Not Living With You	A value is required.	Nearest Relative Relationship	A value is required.
Nearest Relative Address	A value is required.	Nearest Relative Telephone	A value is required.

Employer Info
Employment situation:	Please select an item.	If other, please describe situation.
Employer's Name	A value is required.	Employer's Address		A value is required.
Business Telephone	A value is required.Invalid format.	How Long Employed or Retired?		A value is required. years
Occupation	A value is required.	Self-Employed?		Please select an item.
Gross Monthly Income	A value is required.	Income Pay Period
Previous Employer's Name and Address	A value is required.	How long did you work at your previous job?	years
Additional Income Source		Additional Comments About Income Source(s)

Principals
To be completed if a Corporation or Partnership
Type of Business		State of Incorporation
Name of Principal / Applicant		Title
Years in Position?		% of Ownership	%
Date of Incorporation	Invalid format.	Tax ID
Business Phone	Invalid format.	Business Street Address
Apt./Suite		PO Box
Most Recent Financial Statement Date		Number of Employees
Bank Name		Checking Acct. Nbr.
Contact Name at Bank		Bank Contact Phone	Invalid format.
Other Net Monthly Income		(You do not have to reveal alimony, child support, or separate maintenance income unless you wish to have them considered for approving your application.)
Source		$

Applicant Credit References

Reference	Name of Creditor / Credit Card Co.	Address, Branch, Phone, or Credit Card Number	Status
Include finance companies, banks, credit cards, charge accounts, suppliers. WA: Indicate any other name(s) under which credit references and/or credit history may be verified.
Have you ever declared bankruptcy?	Please select an item.	If yes, when?
1st
2nd
3rd
	Date Open	High	Term	Payments
1st
2nd
3rd
		Balance
1st
2nd
3rd
Prev. Car Financed or Leased With:	Prev. Acct. with Creditor?	Bank or Savings Loan Accountant
Branch or Address			Type of Account
Debts: List all debts including alimony, child support, separate maintenance. Use separate page if needed.	$ per month	Debts:

Co-Applicant

If you are applying for joint credit, whether with a spouse or other second person, this section must be filled.

First Name		Last Name
MI	Nbr. in Family	Social Security Number	Invalid format.
Street Address		City
State		Zip Code	Phone	Invalid format.
Email			Date of Birth Invalid format.
Marital Status		U.S. Citizen?
Drivers License Number		Drivers License State
Drivers License Exp. Date

Housing Info
Housing Status	Rent per Month ($)	How Long at Current Address (years/mo)?
Current Mailing Address (if different)		Previous Address (if less than 2 years)
Number of Years (at previous address)		Mortgage Company/Landlord
Mortgage Balance	$	Market Value	$
Nearest Relative Not Living With You		Relationship
Nearest Relative Address		Nearest Relative Telephone

Employer Info
Employment situation:		If other, please describe situation.
Employer's Name		Employer's Address
Business Telephone	Invalid format.	How Long Employed or Retired?
Occupation		Self-Employed?
Gross Monthly Income		How Long Employed?
Previous Employer's Name and Address		Income Pay Period
Additional Income Source		Additional Comments About Income Source(s)

Co-Applicant Credit References

Reference	Name of Creditor / Credit Card Co.	Address, Branch, Phone, or Credit Card Number	Status
Include finance companies, banks, credit cards, charge accounts, suppliers. WA: Indicate any other name(s) under which credit references and/or credit history may be verified.
Have you ever declared bankruptcy?		If yes, when? Describe
1st
2nd
3rd
	Date Open	High	Term	Payments
1st
2nd
3rd
		Balance
1st
2nd
3rd
Prev. Car Financed or Leased With	Prev. Acct. with Creditor?	Bank or Savings Loan Accountant
Branch or Address			Type of Account
Debts: Total all debts including alimony, child support, separate maintenance. Use separate page if needed.	$ per month	Debts: List name and amount

Asset and Liability Statement

Description	Cash or Market Value	Creditor's Name Address	Mo. Pmt/Mo. Left to Pay	Unpaid Balance
Checking Name:	$			$
Savings Name:	$			$
Stocks and Bonds (No. and Description)	$			$
IRA Accts	$			$
Real Estate Owned (Enter Market Value from Schedule of Real Estate Owned)
	$
Vested Interest in Retirement Fund	$			$
Net Worth of Business Owned (Fax or Mail Financial Statement)		Real Estate Loans: (Enter Total Amount of Mortgages from Schedule of Real Estate Owned)
	$			$
Automobiles Owned (Make & Year)	$	Automobile Loan -- Lender Name		$
Other Assets (Itemize)	$			$
Other Assets (Itemize)	$			$
Total Assets (A)		Net Worth (A minus B)	Total Liabilities (B)

Vehicle

Vehicle Condition	Mileage
Vehicle Identification Number	Year
Make	Model
Engine	Vehicle Has	A/C
		P.S./P.B.
		A/T
List Other Equipment
Trade In	Year
Make	Model
Engine	Vehicle Has	A/C
		P.S./P.B.
		A/T
List Other Equipment
Mileage	Other Charges: Life/A & H-$
Other Charges: Serv. Cont.-$	Other Charges: Other-$
Cash Price
Cash Down $	+ Rebate $
Trade-in Allowance	Owing on Trade
Financed By	Net Trade-In
Total Down Payment	Unpaid Balance of Cash Price
Total of Other Charges to be Financed	Total Amount to be Financed (# Months)
Insurance Information	Insurance Company
Agent's Name	Phone No.	Invalid format.

When you press the submit button, you will be directed to a printable page. You must print that page because it requires a signature. If there is a joint applicant, the joint applicant must also sign the application.