APPLICATIONQUESTIONAIRE

NORTHERN STATE AUTO, INC. 210 SOUTH WALNUT STREET ELMIRA, NY 14904 (607) 734-3752 FAX – (607) 734-1031

Name

DATE

Date

Information requested is voluntary and strictly confidential. You do not have to answer any question(s However, unless you are totally certain you can obtain a loan and/or have a pre-arranged loan secured; the more information provided the better chance of success will be to obtain a loan/vehicle.

A down payment may increase success - the higher the down payment the better. 1. Do you have a down payment? 2. If yes, amount?

YES

NO

3. If no, are you able to obtain one?

YES

NO

4. If yes, by when?

5. Is there somebody able to help if need be with a down payment? If yes, whom?

YES

NO

Not Sure

Relationship?

6. Have you had or currently have car loan(s),

credit card(s), line(s) of credit, etc.? Explain what for/through/how etc

YES

NO

7. Any of your circumstance(s) to change - example less rent, more hours at work, etc.?

Explain

When are, if so, any of your circumstances expected to change?

8. Is there a certain lender you have in the past utilized or worked with, spoke to etc.? Had loan(s) with?

Spoken to/with recently regarding/preapproval etc.

Preferred lender

9. Are any of your expenses shared?

YES

NO

If yes, which expenses?

10. Do you have anyone willing to help you

With the loan payment? If yes, whom?

YES

NO

11. As often requested/necessary for/by a lender is there anyone you know of who would be willing to CO-SIGN/be a co-signer to/for this loan? 12 In the event we are unable to secure a loan to you, do you know of anyone that would be willing to take the loan out in their name then you pay them the loan payment? If yes, whom?

YES

NO

YES

NO

13. Would you like us to try Special Financing at potentially an accelerated interest rate and potential acquisition fees should conventional financing fail? 14. Do you know what your Credit Score is?

YES YES

NO NO

Not Sure Not Sure

If yes, what is it or what do you think it is?

15. Would you be interested in an Extended Warranty

to/on/for your vehicle purchase

?

NO

I need more information

16 Name, address, phone and relationship of nearest relative not living with you*

Questions, concerns, comments