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Finance Form

Finance Form

General Information

First Name: *
Last Name: *
Email: *
Social Security #: *		Ex. 123-45-6789
Birthdate: *		Ex. 08/14/1969
Address: *
City: *
State: *
Zip Code: *
Home Phone: *		Ex. 404-555-1212
Time at Residence:		Years Months
Residence Type:
Rent/Mortgage: *	$

Financing Information

Pre-qualify me for a loan on a similar car if this specific car is out of stock.
Financing Preferred:
Loan Term (Months):
Amount Required:	$
Downpayment:	$
Trading in Vehicle?
Year:
Make:
Model:
Mileage:
Estimated Payoff:	$

Employment Information

Employer: *
Gross Monthly Income: *	$
Occupation: *
City: *
State: *
Zip Code: *
Work Phone: *		Ex. 404-555-1212
Time on Job:		Years Months
Other Income Source:		Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Gross Amount:	$

Additional Comments

If you're a resident of California, Maine, Massachusetts,
New York, Ohio, Rhode Island, Vermont, Washington, or
Wisconsin, please scroll down to read the notice called
for under the law of your state. By submitting this
application, you represent that you've read the notice
required under the law of your state.

CALIFORNIA RESIDENTS: A married applicant may apply
for an individual account.

MAINE RESIDENTS: Consumer reports (credit reports)
may be obtained in connection with this application.

If you request, the creditor will inform you: (1)
whether or not consumer reports were obtained, and
(2) if reports were obtained, the names and addresses
of the consumer reporting agencies (credit bureaus)
that furnished the reports. You have the right to
choose the agent and insurer for the insurance required
by this transaction, but the insurer must be approved by
the creditor.

MASSACHUSETTS RESIDENTS: Massachusetts law prohibits
discrimination on the basis of marital status or sexual
orientation.

NEW YORK RESIDENTS: A consumer credit report may
be requested in connection with this application
or in connection with updates, renewals, extensions
or enforcement of any credit granted as a result
of this application. Upon your request, the
creditor will inform you whether or not a consumer
credit report was requested, and if so, the name
and address of the agency that furnished such report.

OHIO RESIDENTS: The Ohio laws against discrimination
require that all creditors make credit equally available
to all credit worthy customers, and that credit
reporting agencies maintain separate credit histories
on each individual upon request. The Ohio Civil Rights
Commission administers compliance with this law.

RHODE ISLAND RESIDENTS: A consumer credit report
may be requested in connection with this application.

VERMONT RESIDENTS: I authorize the creditor to obtain
credit reports on an ongoing basis about me from credit
reporting agencies in connection with this extension
of credit transaction. The creditor may obtain
credit reports about me on an ongoing basis in
connection with this extension of credit transaction
for any one or more of the following reasons:
(1) reviewing the account;
(2) increasing the credit line on the account;
(3) taking collection action on the account; or,
(4) any other legitimate purposes associated
with the account.

WASHINGTON RESIDENTS: Please advise us if the creditor
should investigate your credit references and/or credit
history under another name.

MARRIED WISCONSIN RESIDENTS: No provision of a marital
property agreement, a unilateral settlement agreement
under Wis. Stat. §766.59, or a court decree under
Wis. Stat. §766.70 adversely affects the interest
of the creditor unless the creditor, prior to the
time the credit is granted, is furnished a copy of
the agreement, statement or decree, or has actual
knowledge of the adverse provision.

ACKNOWLEDGMENT AND CONSENT: I certify that the above information is complete and accurate to the best of my knowledge. Creditors receiving this application will retain the application whether or not it is approved. Creditors may rely on this application in deciding whether to grant the requested credit. False statements may subject me to criminal penalties. I authorize the creditors to obtain credit reports about me on an ongoing basis during this credit transaction and to check my credit and employment history on an ongoing basis during the term of the credit transaction. If this application is approved, I authorize the creditor to give credit information about me to its affiliates.

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