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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

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?
Reference Name of Creditor /
Credit Card Co.

Address, Branch, Phone, or
Credit Card Number

Status  
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

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
Reference Name of Creditor /
Credit Card Co.

Address, Branch, Phone, or
Credit Card Number

Status  
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.