Prepared by: Agent / Referred by: Date:
CREDIT APPLICATION □ PURCHASE □ LEASE
IMPORTANT: BEFORE COMPLETING THIS FORM, READ THE DIRECTIONS I, the application, am applying for credit in my name only, relying only on my own assets and income. None
CAREFULLY: (Check appropriate box at right): of the 3 checkbox items below apply to me.
I, the applicant, intend to rely in whole or in part on the assets or income of another person, the co-
applicant, for repayment.
Alimony, child support, or separate maintenance income need to be revealed if you I, the applicant, am married and live in California or another community property state. Thus, information
do not wish to have them considered as a basis of repaying this obligation. about my spouse is included.
NOTE: APPLICANT, IF MARRIED, MAY APPLY FOR A SEPARATE ACCOUNT. The vehicle is being purchase for the use of another person instead of, or in addition to, me the applicant.
Thus, the other person is included as co-applicant.
APPLICANT INFORMATION Co-Signer: □ YES □ NO
LAST NAME FIRST NAME INITIAL BIRTHDATE DRIVER’S LICENSE NO.
SOCIAL SECURITY NO. E-MAIL ADDRESS HOME PHONE NUMBER
ADDRESS CITY STATE ZIP How Long
YRS MO.
PREVIOUS ADDRESS CITY STATE ZIP How Long
YRS MO.
OCCUPATION PRESENT EMPLOYER WORK PHONE NUMBER
WORK ADDRESS CITY STATE ZIP How Long
YRS MO.
PREVIOUS EMPLOYMENT ADDRESS CITY STATE ZIP WORK PHONE NUMBER How Long
YRS MO.
Applicant's gross monthly income from employment ……………………………………………………………………….…………
Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for
INCOME
repaying this obligation.
Amount: $
Alimony, child support, separate maintenance received under: □ court order □ written agreement □ verbal understanding
Amount of other monthly income and source(s) ………………………………………………………………………………………… Amount: $
TOTAL MONTHLY INCOME: $
□ Rent □ Own Address: ______________________________________________________ Mortgage Balance: $___________________ Rent Payment: $___________
FOUR SQUARE
PRICE TRADE IN INFORMATION VALUE TRADE IN INFORMATION
YR/MAKE/MODEL:
VIN:
DOWNPAYMENT MONTHLY PAYMENT MILEAGE:
(Bank Requirement 30%)
PAY-OFF: COLOR:
ACCIDENT: Yes OR No
CREDIT REPORT
EX: Satis A. Old Trade
TU: Now D. Open Car Loan
EQ: Was D. First Time Buyer
FAIR CREDIT REPORTING ACT DISCLOSURE: This application for credit may be submitted by the dealer to various financial institutions, including those listed
below, in connection with possible purchase or authorization of a vehicle contract. Upon request, names of other institutions receiving this application will be
provided. Financial Institution(s) and Address(es):
The undersigned jointly and severally (1) certify the above information to be accurate and complete and intend it be relied upon to judge creditworthiness; 22 (2) agree that this
application and all related information may be indefinitely retained whether or not credit is extended; (3) certify that the vehicle will not be used for any illegal or restricted purpose; (4)
authorize consumer credit reports and investigations of asset, dept, and employment history to be obtained in connection with this application and for any updates, review, collection,
renewal or extension of the credit received; (5) authorize the exchange of credit, account and financial information about the undersigned, AND UNLESS THE CIRCLE THAT FOLLOWS
IS MARKED, AUTHORIZE THE DEALER AND ANY ASSIGNEE OR OTHER PERSON TO WHOM THIS APPLICATION IS SUBMITTED TO SHARE AND USE INFORMATION ABOUT ME,
INCLUDING INFORMATION IN MY APPLICATION, WITH OTHER ENTITIES THAT ARE RELATED TO THEM BY COMMON OWNERSHIP OR AFFILIATED WITH THEM BY COMMON
CONTROL., IF THE CIRCLE IS MARKED, I DIRECT THE DEALER AND ANY ASSIGNEE OR OTHER PERSON TO WHOM THIS APPLICATION IS SUBMITTED NOT TO GIVE
INFORMATION TO SUCH ENTITIES (OTHER THAN INFORMATION ON THEIR OWN TRANSACTIONS AND EXPERIENCES); (6) agree to be solely responsible for making arrangements
for delivery of communications to be provided to the undersigned in connection with this application; and, (7) I ALSO ACKNOWLEDGE RECEIPT OF A COPY OF THIS APPLCATION.
Applicants Signature Applicants Signature
Date: Date:
NOTE:
