Applicant Information

if you are or will have a co-signer, the co-signer also needs to fill this form out. If you are a co-signer, please indicate the person you are co-signing for below. Required fields marked with an *

First Name* Last Name* Middle Name Date of Birth* Social Security #* Drivers License #* Drivers License State* Home Phone* Work Phone E-mail Street Address 1* Street Address 2 City* State* Zip* Residence Own Buying Rent Parents Other Time lived there: Years Months Monthly Payment/Rent $

Previous address if at above residence for less than 3 years.

Previous Address 1 Previous Address 2 Previous City Previous State Previous Zip Time lived there: Years Months

Employment & Income Information

Note: Alimony, child support or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for repaying this obligation.

Employer Name Length of Employment Years Months Employer Address Employer City Employer State Employer Zip Occupation Monthly Gross Income $

Previous Employer if at above Employer for less than 3 years.

Prev. Employer Name Length of Employment Years Months Prev. Employer Address Prev. Employer City Prev. Employer State Prev. Employer Zip Prev. Occupation Prev. Monthly Gross Income $

Credit & Debit Information

Bank Reference Checking Savings Mortgage Payment (if any) Mortgage Creditor (if any) Mortgage Balance (if any) $
Auto Loan Payment (if any) Auto Loan Creditor (if any) Auto Loan Balance (if any) $
Other Loan Payment (if any) Other Loan Creditor (if any) Other Loan Balance (if any) $
Has any party to this application been the subject, or subject to bankruptcy proceedings? Yes No If yes, please explain circumstances.
Has any party to this application ever obtained credit under a different name? Yes No If yes, under which name?
Has any party to this application ever had a vehicle repossessed? Yes No If yes, please explain circumstances.

References

Nearest Relative not living with you: Name Address City State Zip Phone Relationship to Applicant
2nd Reference Name Address City State Zip Phone Relationship to Applicant
3rd Reference Name Address City State Zip Phone Relationship to Applicant
I certify that the above information is true and correct to the best of my knowledge. By signing below, I give authority to the recipient of this Credit Pre-Approval Application Form to gather any necessary credit and reference information on my behalf for the sole purpose of determining credit worthiness. I recognize that by submitting this form for credit pre-approval that I agree to the terms set forth in this disclaimer. I understand that to complete the credit approval process, I will need to visit the dealership in person.

Signature* Date* (MM/DD/YYYY)
All customer information is protected by Title V of the Gramm-Leach-Bliley Act, 15 U.S.C., Section 6801 through 6810, and the Federal Trade Commission's Regulation P, 16 C.F.R. Part 313, with regard to the unauthorized distribution of non-public customer information to third parties for any purpose other than its intended use. Whereas, by use of this form, customer acknowledges that any information submitted may be utilized by recipient for its itended purpose.