FINANCE

Application Information
Individual or Joint Application (co-applicants must each fill out their own application)

Individual Joint
Product Inquiry (Please use stock number if available) *
Price of Product *
Identification
Name *

First

Last
Date of Birth *
SSN *
Marital Status *
Are you a U.S. Citizen? *
Driver's License No. *
D.L. Expiration Date *
Contact Information
Phone *
Mobile Phone *
Email Address *
Address Information
Street Address *
Street Address Line 2
City *

Postal / Zip Code *
State / Province *

County *
Years at Current Residence *
Months at Current Residence *
Do you rent or own? *
Landlord or Mortgage Company *
Monthly Rent / Mortgage *
Landlord or Mortgage Company Phone *
Mailing Address (if different from physical address)
Street Address
Street Address Line 2
City

Postal / Zip Code
State / Province

County
Previous Address

If less than two years at current residence, please complete previous history information below.
Years at Previous Residence
Months at Previous Residence
Street Address
Street Address Line 2
Previous City

Previous Postal / Zip Code
Previous State Province

Previous County
Employment History
Current Employer (Actual Employer) *
City of Employer *
State of Employer *
Position / Occupation *
Employer Phone *

Gross Monthly Income (before taxes) *

Years at Job *

Months at Job *
Previous Employer (if less than two years at your current job)
Previous Employer Phone
Years at Job

Months at Job
Questionnaire
Other Monthly Income *

Source of Other Monthly Income *

Have you ever filed for bankruptcy? *

If yes, when?

Have you ever had a car or other merchandise repossessed? *

If yes, when?
Personal References - nearest relative not living with you
Name *

First

Last
Relationship *
Phone *
City *

Postal / Zip Code *
State / Province *

County *
Name *

First

Last
Relationship *
Phone *
City *

Postal / Zip Code *
State / Province *

County *
Additional Information
Sales Consultant's Name
Delivery Method *

Pickup at Dealership Delivery to Residence Deliver Elsewhere
Credit Report Authorization
Initials *

I certify that the information provided by me is correct. I also understand that you will be checking with credit reporting agencies. I authorize an investigation of my credit and employment history and the release of information about my credit experience. I have read and received a copy of your Privacy Notice and agree to all of the above.