Loan Application Form

BASIC INFORMATION
Personal Information
Name

First NameLast Name
Suffix:
Social Security Number
Phone Number
Format: (000) 000-0000.
E-mail
Birth Date

MonthDayYear
Drivers License #
Drivers License State
License Expiration Date

MonthDayYear
Current Housing Information
Housing Type
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
How long have you lived in your given address?
Home Payment
Employment Information
Present Employer
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Job Title
Present Employer Duration (Years)
Present Employer Duration (Months)
Employer Phone
Format: (000) 000-0000.
Applicant's Net Period Paycheck
Salary Type
Additional Income
Military Experience
Personal References

We May use personal references for verification, servicing, and collection purposes.
Reference #1

First Name

Last Name

CityState

Phone Number
Reference #2

First Name

Last Name

CityState

Phone Number
Reference #3

First Name

Last Name

CityState

Phone Number
Reference #4

First Name

Last Name

CityState

Phone Number
Disclaimer
I, the applicant and any co-applicant, agree that if an account is created for me, all of the following will apply: (a) creditor, and any assignee of the creditor may monitor and record telephone calls regarding your account to assure the quality of our service or for other reasons; (b) I expressly consent to creditor, and any assignee of creditor using prerecorded/artificial voice messages, text messages and/or automatic dialing equipment while serving or collecting my account, as the law allows; (c) I agree that creditor and any assignee of creditor may take these actions using the telephone number(s) that I provide creditor, and any assignee of creditor in this credit application, I provide to creditor, and any assignee of creditor in the future,or creditor, and any assignee off creditor gets from another source, even if the number is for a mobile telephone and/or using the number results in charges to me. This application will be submitted to U.S. AutoFinance, Inc. P.O. BOX 1073 Wilmington, DE 19899. I agree that if I gave creditor a mobile phone number in creditor's application, or if I later gave creditor a mobile phone number, or if creditor gets a mobile phone number for me from another source, creditor may contact me by text message or phone call on that mobile phone regarding my account, notwithstanding the fact that there is a possibility that a third party may see creditor's text message to me, and I represent that any mobile phone number I gave creditor or will give creditor is my mobile phone number alone. I agree this consent applies to any assignee of creditor. By signing below, I certify that the information in my application is complete and true. I have read the disclosures on this credit application. I authorize the creditor and any assignee of the creditor 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 creditor, and assignee of the creditor to obtain credit reports,and verify my employment and/or residence for purpose of reviewing or taking collection action on the account or for other legitimate purpose associated with the account.
I hereby agree that the information given is true, accurate and complete as of the date of this application submission. *
Signature
Available Down Payment
Please Upload Your: - Driver's License
Please Upload Your: - Proof Income (I.E. Check Stubs or Bank Statement)
Please Upload Your: - Additional Income (If Necessary)
Please Upload Your: - Proof of Residence (I.E. Mail or Lease)
Should be Empty:

BASIC INFORMATION

Personal Information

Current Housing Information

Employment Information

Personal References

Disclaimer