CREDIT APPLICATION
APPLICATION TYPE
TYPE OF APPLICATION
Individual Credit
Joint Credit (Co-Applicant must complete separate or joint sections)
VEHICLE REFERENCE (YEAR, MAKE, MODEL)
PRIMARY APPLICANT INFORMATION
FULL LEGAL NAME ( FIRST, MIDDLE, LAST)
First Name
Last Name
SOCIAL SECURITY NUMBER (SSN)
*
XXX-XX-XXXX
DATE OF BIRTH (MM/DD/YYYY)
-
Month
-
Day
Year
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DRIVER'S LICENSE NUMBER & STATE
EMAIL ADDRESS
example@example.com
PRIMARY PHONE NUMBER
Format: (000) 000-0000.
CURRENT RESIDENTIAL ADDRESS
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
HOUSING STATUS
Own
Rent
Other
MONTHLY RENT / MORTGAGE PAYMENT
TIME AT CURRENT ADDRESS (YRS / MOS)
PREVIOUS ADDRESS (IF CURRENT IS LESS THAN 2 YEARS)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
TIME AT PREVIOUS ADDRESS
PRIMARY EMPLOYMENT & INCOME INFORMATION
CURRENT EMPLOYER NAME
OCCUPATION / POSITION
TIME AT CURRENT JOB (YRS / MOS)
EMPLOYER ADDRESS
Street Address, City, State
Street Address Line 2
City
State / Province
Postal / Zip Code
WORK PHONE NUMBER
Format: (000) 000-0000.
GROSS MONTHLY INCOME
PREVIOUS EMPLOYER NAME (IF CURRENT IS LESS THAN 2 YEARS)
PREVIOUS OCCUPATION / POSITION
TIME AT PREVIOUS JOB (YRS / MOS)
OTHER INCOME SOURCE (ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT BE REVEALED IF YOU DO NOT WISH TO HAVE IT CONSIDERED)
AMOUNT OF OTHER MONTHLY INCOME
CO-APPLICANT / CO-SIGNER INFORMATION
CO-APPLICANT FULL LEGAL NAME (FIRST, MIDDLE, LAST)
First Name, Middle Name
Last Name
SOCIAL SECURITY NUMBER (SSN)
XXX-XX-XXXX
DATE OF BIRTH (MM/DD/YYYY)
-
Month
-
Day
Year
Date Picker Icon
DRIVER'S LICENSE NUMBER & STATE
RELATIONSHIP TO APPLICANT
PRIMARY PHONE NUMBER
Format: (000) 000-0000.
CO-APPLICANT RESIDENTIAL ADDRESS (IF DIFFERENT)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
CURRENT EMPLOYER NAME
OCCUPATION / POSITION
TIME AT CURRENT JOB (YRS / MOS)
EMPLOYER ADDRESS (ADDRESS, CITY, STATE, ZIP CODE)
Street Address
Street Address Line 2
ADDRESS, CITY, STATE, ZIP CODE
State / Province
Postal / Zip Code
WORK PHONE NUMBER
Format: (000) 000-0000.
GROSS MONTHLY INCOME
PREVIOUS EMPLOYER NAME (IF CURRENT IS LESS THAN 2 YEARS)
PREVIOUS OCCUPATION / POSITION
TIME AT PREVIOUS JOB (YRS / MOS)
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LEGAL DISCLOSURES & NOTICES
CALIFORNIA RESIDENTS NOTICE:
A married applicant may apply for a separate account. As required by law, you are hereby notified that a negative credit report reflecting on your credit record may be submitted to a credit reporting agency if you fail to fulfill the terms of your credit obligations.
Applicant Statement & Authorization:
By signing below, I/we certify that all information provided in this credit application is true, correct, and complete to the best of my/our knowledge. I/we authorize
No Haggle Auto Brokers, LLC
and any potential financial institutions or lending partners to whom this application is submitted to conduct a comprehensive credit investigation. This includes, but is not limited to, obtaining credit reports from credit reporting agencies, verifying employment histories, income sources, bank account balances, and contacting any references listed herein. I/we understand that this application will be retained whether or not credit is approved.
Signature
DATE
-
Month
-
Day
Year
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Signature
DATEDate
-
Month
-
Day
Year
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License and Current Insurance File Upload
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