Credit Application

CREDIT APPLICATION

• If you are applying for individual credit in your own name and are relying on your own income or assets and NOT the income or assets of another person as a basis for repayment of the credit requested, complete Section 1 and sign.
• If you are married and live in a community property state, complete all sections including Section 2 and sign.
• If this is an application for joint credit with another person, complete all sections, using Section 2 for the co-applicant.

Applicant Information
First Name:
Middle Name::
Last Name:
Address Street 1:
Address Street 2:
City:
State::
Zip Code:	(5 digits)
Rent/Mortgage Payment Amount::
Social Security #::
Date of Birth::
Time at residence::
Place of Employment::
Address of Employer::
Job Title::
Time at Current Employer::
Supervisor's Name::
Gross Monthly Income::
Daytime Phone:
Evening Phone:
Employers Phone::
E-mail address:
Co-Applicant Information
First Name:
Middle Name::
Last Name:
Address Street1::
Address Street 2::
City::
State:
Zip Code::
Time at Residence::
Rent/Mortgage Payment Amount::
Social Security Number::
Date of Birth::
Name of Employer::
Address of Employer::
Job Title::
Time at Current Employer::
Supervisor's Name::
Gross Montly Income::
Daytime Phone:
Evening Phone:
Employers Phone:
E-mail address:
Financial Information
Down Payment(15-20% recommended):
Loan Amount:	(USD)
Vehicle Information::
Stock#:
Make:
Model:
Year:
Other Information
Comments:	Enter comments here!
	I/we certify that the above information is complete and accurate. You, the Seller, are authorized to investigate my credit and employment history, including obtaining my credit report from any credit reporting agency of your choice. My/our authorization extends to affiliates of the Seller, including Assignees to whom the Seller may offer for purchase the installment credit contract being considered herein. I acknowledge that I have received a copy of this Credit Application.