Finance Application

1

DateTime

2

Dealer Name

3

Amount Requested to be Financed* This field is required.

4

Name of Applicant* This field is required.

First Name

Middle Name

Last Name

5

Social Security Number* This field is required.

6

Birthdate* This field is required.

Date

7

Address* This field is required.

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

8

Contact Number

Please enter a valid phone number.

9

Time at Current Address (YRS-MOS)* This field is required.

10

Own or Rent Home* This field is required.

Own

Rent

11

Monthly Mortgage or Rent Payment* This field is required.

12

Mortgage Balance

13

Estimated Home Value

14

Previous Address (if less than 3 years)

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

15

Current Employer* This field is required.

16

Current Occupation* This field is required.

17

Time at Current Employer (YRS-MOS)* This field is required.

18

Current Employer Phone* This field is required.

Please enter a valid phone number.

19

Current Salary* This field is required.

20

Current Pay Frequency* This field is required.

21

Net Monthly Income Amount

22

Other Income Amount

23

Source of Other Income

24

Total Monthly Income Combined* This field is required.

25

Previous Employer

26

Previous Time at Employer (YRS-MOS)

27

Bankrupt in Last 10 Years?* This field is required.

Yes

No

28

Reason for Bankruptcy

29

Do you need a Co-Applicant?* This field is required.

Yes

No

30

Co-Applicant Name

First Name

Middle Name

Last Name

31

Co-Applicant Current Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

32

Co-Applicant Contact Number

Please enter a valid phone number.

33

Co-Applicant Social Security Number

34

Co-Applicant Birthdate

Date

35

Co-Applicant Time at Current Address (YRS-MOS)

36

Co-Applicant Own or Rent Home?

Own

Rent

37

Co-Applicant Monthly Mortgage

38

Co-Applicant Mortgage Balance

39

Co-Applicant Estimated Home Value

40

Co-Applicant Previous Address (if less than 3 years)

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

41

Co-Applicant Current Employer

42

Co-Applicant Current Occupation

43

Co-Applicant Time at Employer (YRS-MOS)

44

Co-Applicant Current Employer Phone

Please enter a valid phone number.

45

Co-Applicant Salary

46

Co-Applicant Pay Frequency

47

Co-Applicant Net Income Amount

48

Co-Applicant Other Income Amount

49

Co-Applicant Other Income Source

50

Co-Applicant Total Monthly Income

51

Co-Applicant Previous Employer (if less than 3 years)

52

Co-Applicant Previous Employment Time (YRS-MOS)

53

Co-Applicant Bankrupt in Last 10 Years?

Yes

No

54

Co-Applicant Bankruptcy Reason

55

Subtotal of Amount Financed* This field is required.

56

Down Payment

Yes

No

57

Down Payment Amount

58

Ridgenet Network Group Invoice Number

59

Applicant Signature

Clear

60

Co-Applicant Signature

Clear

61

Please verify that you are human* This field is required.