* Required Field  
Credit Application - Primary
Date Taken Application taken By
Vehicle To Be Purchased
Stock # Year Make Model Mileage
Salesman
Source
Selling Price
Down Payment
Payment Wanted
Applicant
First Name MI Last Name
Date of Birth # of Dependents and Ages Social Security #
Marital Status
Driver's License # State Exp. Date
Home Phone Cell Phone Pager
Current Address
Address Line 1
Address Line 2
City State Postal Code
How long at this residence: Years Months
Are you
Are you on the lease or mortgage?
Who do you live with?
If leasing is it?
Landlord/Mortgage Holder Landlord/Mortgage Holder Phone #/Account #
This is a
What is your monthly rent or mortgage payment? Is the payment current?
Previous Address (if less than 3 years)
Address Line 1
Address Line 2
City State Postal Code
How long at this residence: Years Months
What is your mailing address if different from above?
How long have you lived in this area? How many residence changes have you had in the last 5 years?
Employment
Current Employer Hire Date
Address Phone
Supervisor Name Your Job Title - Position
Are you paid hourly or salary?   Amount?
How often are you paid?
What day of the week is payday on?
How many hours do you work a week? What is your pay after taxes?
Miles to work, one-way?
Former Employers (if less than 3yrs)
Employer Address Phone
Dates Employed There Position/Job Title
Reason for leaving
Employer Address Phone
Dates Employed There Position/Job Title
Reason for leaving
How many job changes have you had in the last 5 years?
Other Income
Do you have a part-time job?
Other sources of income? *
* (Spousal income, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.)
Net Monthly Income from Other Sources
Banking Accounts
Checking Account No. And Bank
Savings Account No. And Bank

Credit Application - Co-Applicant
Do You Have a Co-Applicant?

Primary Applicant Credit References
Please list all current outstanding debts and monthly expenses
Outstanding Debts
Auto Creditor Name Phone Loan Type/Account #
Balance Payment Amount Amount Past Due
Reason for being past due or in default
Creditor Name Phone Loan Type/Account #
Balance Payment Amount Amount Past Due
Reason for being past due or in default
Creditor Name Phone Loan Type/Account #
Balance Payment Amount Amount Past Due
Reason for being past due or in default
Are these all your outstanding debts?
Estimated Expenses
Please write in what you estimate your expenses are for the following items on a monthly basis.
Cable/Satellite TV
Child Care
Auto Insurance
Gasoline
Food
Electric
Water
Telephone/Cell Phone
Paid Accounts
Please List Your Paid Accounts
Creditor Phone Type Loan/Account #
Creditor Phone Type Loan/Account #
Creditor Phone Type Loan/Account #
What vehicle do you drive now? Is it paid for?
Financed by?
Please list all additional drivers
Have you ever had a vehicle repossessed?
Have you ever filed for bankruptcy in the last 10 years?
Are you contemplating bankruptcies, or visited an attorney about filing for bankruptcy?
Are there any unsatisfied judgements against you?
Are there any tax liens?
Do you pay child support?
Are you in the military?
The vehicle I am purchasing is for
The vehicle being purchased is for    Who?

Co-Applicant Credit References

Primary Applicant Personal References
Name Relation
Address
City State Postal Code
Phone Years Known
Name Relation
Address
City State Postal Code
Phone Years Known
Name Relation
Address
City State Postal Code
Phone Years Known
Name Relation
Address
City State Postal Code
Phone Years Known

Co-Applicant Personal References