Finance Application
Name (Nombre)
*
First Name
Last Name
Address (Direccion)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone # (Numero de telefono)
*
Please enter a valid phone number.
Email (Correo Electronico)
*
example@example.com
Date of Birth (Fecha de nacimiento)
*
-
Month
-
Day
Year
Date
Social Security # (# de seguro)
*
Do you rent or own? (Renta o es dueno de casa?)
*
Please Select
RENT
OWN
Driver License #/State (Numero de Licencia y Estado)
*
Ex. 1123456789 / TX
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SOURCE OF PRIMARY INCOME
Fuente de ingresos primaria
Employer (Empleador)
OR
Self-Employment
Social Security
Retirement
Pension
Disability
Employer Zip (Postal de empleador)
Employer City (Ciudad de Empleador)
State (Estado)
Employer Phone # (Numero de telefono de empleador)
Hire Date (Fecha de contratacion)
-
Month
-
Day
Year
Date
Monthly Income (Ingreso Mensual)
*
When are you paid? (Cuando se le paga?)
*
Weekly or Bi-weekly. Por semana/quincena
Is your check direct deposited to your bank account? (Es su cheque depositado directamente a su cuenta de banco?)
*
YES
NO
Last Payday (Ultimo dia de pago)
*
-
Month
-
Day
Year
Date
Next Payday (proximo dia de pago)
*
-
Month
-
Day
Year
Date
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BANK ACCOUNT INFORMATION
Informacion de banco
Bank Name (Nombre de banco)
Routing # (numero de ruta del Banco.)
Checking Account # (# de cuenta de cheques)
Approximate date you opened the account. (Aproximada fecha abierta)
-
Month
-
Day
Year
Date
Billing Address (Domicilio fiscal)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Two relatives not living with you.
Dos relativos que no viven con usted.
Relative 1 (Relativo 1)
First Name
Last Name
Relationship?
Ex. Dad, sister, mom
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number Relative 1 (Relativo 1 telefono)
Please enter a valid phone number.
Relative 2 (Relativo 2)
First Name
Last Name
Relationship?
Ex. Dad, sister, mom
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number Relative 2 (Relativo 2 telefono)
Please enter a valid phone number.
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Acknowledgment
By clicking 'SUBMIT', I acknowledge that I am signing this Application electronically, and that my electronic signature is the legal equivalent of my written signature on the Application. I consent to be bound by the terms and conditions and important disclosures of the Application. I further understand that I am requesting that “Flat-Out Auto, its partners or its subsidiaries" enter a payment plan agreement with me. I hereby: Certify that all information I have provided or will provide is true, correct, and complete; Consent to receive the disclosures contained in the Application electronically; Consent to"Flat-Out Auto, its partners or its subsidiaries" contacting any person or company listed on my application to obtain information about me and fully release all parties from an claim that may arise out of such contact; Authorize "Flat-Out Auto, its partners or its subsidiaries to charge any credit or debit card (as described in the Application) in the amount of my Initial Payment if my application is approved and I execute a Payment Plan agreement with "Flat-Out Auto, its partners or its subsidiaries" authorizing such a charge;Agree that "Flat-Out Auto, its partners or its subsidiaries" may obtain one or more consumer reports ('Consumer Reports') in connection with either (a) my application, (b) any updates, renewals, or extensions of any transaction resulting from my application ('Transactions'), (c) the review or collection of any Transaction and (d) other legitimate business purposes related to any Transaction; Understand that upon my request (a) I will be informed whether "Flat-Out Auto, its partners or its subsidiaries" obtained Consumer Reports and, if so, the name and address of the individual or company that furnished the Consumer Reports; Authorize "Flat-Out Auto, its partners or its subsidiaries" to share information with the merchant whose goods I am interested in buying ('Dealer') about"Flat-Out Auto, its partners or its subsidiaries" decision to offer me a payment plan, and authorize "Flat-Out Auto, its partners or its subsidiaries" to share my application information and lease terms with Dealer; and understand that I can withdraw my consent by closing this web session without submitting my application.
Signature
*
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