Credit Application
Important: Read these Directions before completing this Application (Check Appropriate Box)
Individual Credit. If application for individual credit without reliance upon the income or assets of another person as the basis for repayment of the credit requested, complete only Sections 1, 3, 4, 5 & 6, omitting Section 2 and the second part of Section 3 (dealing with marital status of other party).
Joint Credit. If application for joint credit with another person, complete all Sections.
Other. If application for individual credit, but applicant is relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as basis for repayment of the credit requested, complete all Sections to the extent possible, obtaining information in 2 about the person on whose alimony, support, or maintenance payments or income or assets applicant is relying.

Section 1: Information Regarding Applicant

Name:  
Last:
First:
Middle:
Date of Birth: Social Security #:
Driver's License #:
Address (Street):
City: State: Zip:
Telephone: Residence Near By
Own/Buy Rent Mobile Home Others
How Long? Years: Months:
Name of Landlord or Mortgage:
Address of Landlord or Mortgage:
Mortgage Payment or Rent:
Previous Address:
How Long: No. of Dependents:
Ages:  
Employer: Position:
Phone: How Long (years):
Address:  
Department: How Paid:
Monthly Net Income:  
Other Income: Applicant need not disclose or rely upon alimony, child support or maintenance payments, unless Applicant so desires. If disclosed, secure the following information:
Source:
Amount: Frequency:
Received Pursuant to: Court Order: Written Agreement:
  Oral Understanding: Other:
Previous Employer:
Address:
Position: How Long (years):
Applicant's Total Net Income:
Name and Address of Nearest Relative(s) not Living with Applicant:
 
Relationship: Telephone:
Relative:
Relationship: Telephone:
Relative:
Relationship: Telephone:

 

Section 2. Joint Applicant (See Instructions Above)

Name:  
Last:
First:
Middle:
Date of Birth: Social Security #:
Driver's License #:
Address (Street):
City: State: Zip:
Telephone: Residence Near By
Own/Buy Rent Mobile Home Others
How Long? Years: Months:
Name of Landlord or Mortgage:
Address of Landlord or Mortgage:
Mortgage Payment or Rent:
Previous Address:
How Long: No. of Dependents:
Ages:  
Employer: Position:
Phone: How Long (years):
Address:  
Department: How Paid:
Monthly Net Income:  
Other Income: Applicant need not disclose or rely upon alimony, child support or maintenance payments, unless Applicant so desires. If disclosed, secure the following information:
Source:
Amount: Frequency:
Received Pursuant to: Court Order: Written Agreement:
  Oral Understanding: Other:
Previous Employer:
Address:
Position: How Long (years):
Applicant's Total Net Income:
Name and Address of Nearest Relative(s) not Living with Applicant:
 
Relationship: Telephone:
Relative:
Relationship: Telephone:
Relative:
Relationship: Telephone:
Credit References - Current or Paid Out Loans
Reference:
Total Monthly Payments:
Reference:
Total Monthly Payments:
Reference:
Total Monthly Payments:
Reference:
Total Monthly Payments:

 

Section 5. Insurance Information

Agent: Ins. Co.
Telephone: Policy Period:

 

Section 6. Customers Current Car(s)

Description of Trade-in:
ACV: Balance Owed on Trade-in:
Where Financed:
If No Trade - Car Customer Now Driving:
Where Financed:
If No Car, What Happened to Last Car?
1