CREDIT APPLICATION
Need Help? Call us at (631) 498-7777 or E-mail speedlinemotors631@gmail.com
Applicant Information
Please complete all fields that have an asterisk
Date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Middle Name
Last Name
Drivers License (Front And Back If Out Of State)
Birth Date
*
Please select a month
January
February
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Month
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31
Day
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1955
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1950
1949
1948
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1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Social Security Number/Tax ID
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Time At Present Address
*
Residence Type
*
Own Outright
Buying
Renting
Family
Other
Monthly Mortgage/Rent Payment
*
Previous Address (if less than two years at present address)
Phone Number
Email
*
example@example.com
Current Employer
*
Employer Phone Number
*
Job Title
*
Time at Present Job
*
Gross Income (before taxes)
*
Alimony, child support, or separate maintenance income need not to be revealed if you do not wish to have it considered as a basis of repaying this obligation
Previous Employer (if less than two years at present employer)
Previous Employer Phone Number
Previous Job Title
Time at Previous Job
Signature
*
Co-Buyer
Date
-
Month
-
Day
Year
Date
Name
First Name
Middle Name
Last Name
Suffix
Drivers License (Front And Back If Out Of State)
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Social Security Number/Tax ID
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Time At Present Address
Residence Type
Own Outright
Buying
Renting
Family
Other
Monthly Mortgage/Rent Payment
Previous Address (if less than two years at present address)
Phone Number
Email
example@example.com
Current Employer
Previous Current Employer
Employer Phone Number
Job Title
Time at Present Job
Gross Income (before taxes)
Previous Employer (if less than two years at present employer)
Previous Employer Phone Number
Previous Job Title
Time at Previous Job
Signature
By signing this application,
I certify that the information in my application is complete and true. I authorize, Speedline Motors and any finance company, to investigate my credit and employment history, obtain credit reports, and release information about their credit experience with me. If an account is created, I authorize the obtaining of credit reports for purposes of reviewing or taking collection action on the account or for other legitimate purposes associated with the account. I agree that you and any assignee of the financing contract or lease may monitor and record telephone calls regarding my account to assure quality of service or for other reasons. I agree that you and any assignee of the financing contract or lease may try to contact me in writing, by e-mail, or using prerecorded/artificial voice messages, text messages, and automatic telephone dialing systems, as the law allows. I also agree that you and any assignee of the financing contract or lease may try to contact me in these and other ways at any address or telephone number I provide, even if the telephone number is a cell phone number or the contact results in a charge to me.
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