creditapplication

Credit Application Form

APPLICANT

Full Name

First NameMiddle NameLast Name

Cell Phone

Format: (000) 000-0000.

E-mail

example@example.com

Birth Date

MonthDayYear

Maritial Status

Social Security Number

Driver's License Number

Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Previous Address (Only if current address is less than 2 years)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How many years at current address?

How many years at previous address?

Employer Name

Position

Employer Phone

Format: (000) 000-0000.

Years Employed

Company Address

Street Address

Street Address Line 2

CityState

Zip Code

Previous Employer Name (Only if current is less than 2 years)

Position

Employer Phone

Years Employed

Previous Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Verifiable Gross Monthly Income (Before Tax)

Monthly Rent or Mortgage

Sales Representative

Signature

Date

File Upload (Driver's License, Current Vehicle Insurance)

FAIR CREDIT REPORTING ACT DISCLOSURE: This application for credit may be submitted by the dealer to various financial institutions

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW CREDIT ACCOUNT - To help the government fight the funding of terrorism and money laundering

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, Federal law requires financial institutions to obtain, verify, and record information that identifies each person who opens an account. Opening an account can include a financial institution accepting assignment of an installment contract or lease.

What this means for you: When opening an account, you will be asked for your name, address, date of birth, and other information that will allow the financial institution to identify you. You may also be asked to show your driver's license or other identifying documents.

By signing below, "you" (the undersigned, jointly and severally): (1) certify the above information to be accurate and complete and intend it to be relied upon by "us" (the creditor and financial institutions receiving this application or to whom the credit is assigned) to judge creditworthiness; (2) authorize us to retain as our property this application and all related materials whether or not credit is extended; (3) certify that the vehicle will not be used for an illegal purpose; (4) authorize us and our affiliates to obtain consumer credit reports and investigations of your credit and employment history in connection with this application and any update, review, collection or modification of the credit extended and to answer questions about our credit experience with you consistent with applicable law and our privacy policy; (5) agree to notify us in writing of changes in name, address, and other information provided above; (6) agree that we and our agents, affiliates, and service providers ("We" or "Us") may from time to time monitor and record telephone calls, emails and text messages made or received by Us regarding your application and any resulting account and subject to applicable law make calls and send email, using prerecorded/artificial voice messages or through the use of an automatic dialing device at any telephone number or email address you have provided or at any future time provide to Us in connection with your application or any account with us, including a mobile telephone number that could result in charges to you;

You agree that we and any assignee of the financing contract or lease may monitor and record telephone calls regarding your account to assure the quality of our service or for other reasons. You agree that we and our assignees may try to contact you in writing, by e-mail, or using prerecorded/artificial voice messages, text messages, and automatic telephone dialing systems, as the law allows. You also agree that we and our assignees may try to contact you in these and other ways at any address or telephone number you provide us, even if the telephone number is a cell phone number or the contact results in a charge to you. You (1) make the above representations, which are certified correct, for the purpose of securing credit; (2) authorize us, affiliated entities, and financial institutions to whom we submit your application (hereinafter "Financial Institutions") to obtain consumer credit reports and to gather employment history as necessary and appropriate to determine your creditworthiness; (3) understand that we or the Financial Institutions will retain this application whether or not it is approved, and that it is your responsibility to update changes of name, address or employment.

Form Submitted On

Date

Hour MinutesAM/PM Option