Customer Application

Name*

First NameLast Name
Phone Number*
Date of Birth*

MonthDayYear
Social Security Number*
Physical Address *

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Do you currently | *
Time at current residence?*
Y- Years | M= Months
Monthly amount of rent, mortgage or housing cost?*
Only include how much you pay yourself.
Previous Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Time at previous address?*
Y- Years | M= Months
Employment Information

If your only source of income is SSI, SSDI, or any source of unearned income, enter that information here. Anyone receiving benefits while employed, enter additional income in the next section.
Employer Name*
Employer Phone Number
Please enter a valid phone number.
Time with current employer?*
Y- Years | M= Months
Position*
Enter N/A if receiving benefits
Hourly Rate of pay*
Enter the gross amount of benefits you receive each month if you receive SSI, SSDI or any other benefits.
Supervisors Name
Name of the person whom we need to speak with to verify employment.
How many hours each week*
Previous Employer*
Time with previous employer?*
Y- Years | M= Months
Additional income- Enter the source of the income and the total monthly amount.
Ex: Benefits check- $800 / month
How much can you comfortably use as a down payment?*
Trade-In Information:

Year Make: Model Odometer
Name of person who referred you

First NameLast Name
Signature| *Please make sure information is correct before signing and submitting**

Clear
By signing above you agree that the information you have submitted is your current information. You're agreeing for M & L Auto Sales to conduct a one time confidential credit inquiry on customers financial responsibility and credit worthiness.
Please verify that you are human*
Should be Empty:

Employment Information