YOUR NAME (First, Middle, Last):
CELL PHONE:
EMAIL:
DATE OF BIRTH:
SOCIAL SECURITY NUMBER:
ADDRESS:
CITY:
STATE/ZIP:
RESIDENTIAL STATUS:
TIME AT ADDRESS:
EMPLOYER NAME:
MONTHLY INCOME:
OCCUPATION:
LENGTH OF EMPLOYMENT:
WORK PHONE NUMBER:
PREVIOUS EMPLOYER NAME:
PREVIOUS EMPLOYER CITY:
PREVIOUS EMPLOYER STATE:
PREVIOUS OCCUPATION:
PREVIOUS LENGTH OF EMPLOYMENT:
PREVIOUS WORK NUMBER:
OTHER INCOME AMOUNT AND SOURCE (MONTHLY):
PERSONAL REFERENCE NAME AND NUMBER:
AGREEMENT
You understand and agree that you are applying for credit by providing the information to complete and submit this credit application. You may keep this application and any other application submitted to us and information about you whether or not the application is approved. You certify that the information on the application and on any other application submitted to us, is true and complete. You authorize us to submit this application and any other application submitted in connection with the proposed transaction to the financial institutions disclosed to you by us the dealers; in addition, in accordance with the Fair Credit Reporting Act, you authorize that such financial institutions may submit your applications to other financial institutions for the purpose of fulfilling your request to apply for credit. This application will be reviewed by such financial institutions on behalf of themselves and us the dealer. You agree that we may obtain a consumer credit report periodically from one or more consumer reporting agencies in connection with the proposed transaction and any update, modification, or extension of that transaction. You also agree that we or any affiliate of ours may obtain one or more consumer credit reports on you at any time whatsoever. If you ask, you will be told whether a credit report was requested, and if so, the name and address of any credit bureau from which we or our affiliate obtained your credit report. You agree that we may verify employment, pay, assets, and that anyone receiving a copy of this is authorized to provide us with such information. You further authorize us to gather whatever employment history we consider necessary and appropriate in evaluating this application and any other applications submitted in connection with the proposed transaction. You understand that we will rely on the information in this credit application in making our decision.
