Personal Credit App

#A(Required)

Primary Applicant(Required)

Primary Applicant

Joint Applicant: Application is for joint credit with primary applicant as guarantor

Joint Applicant: Primary Applicant is relying on me for income for alimony, child support, or separate maintenance or on my income or assets as basis for repayment of credit requested.

Product Type(Required)

Retail

Lease

Other

"You" as used herein, refers to the Dealer, or any other Creditor to whom this application is submitted.

Last Name(Required)

First Name(Required)

Middle Name(Required)

suffix

jr.

sr.

Date of Birth(Required)

SSN(Required)

Drivers License No and State(Required)

Physical Address (Number, Street, Apartment)(Required)

Physical Address City(Required)

Physical Address State(Required)

Physical Address Zip Code(Required)

Mailing Address (Number, Street, Apartment, PO Box)(Required)

Mailing Address City(Required)

Mailing Address State(Required)

Mailing Address Zip Code(Required)

County

Does Applicant have a Phone in home(Required)

Yes

Phone in Home Number

Home Type(Required)

Own Home outright

Buying Home

Living with Relatives

Leasing/Renting

Own/Buying Mobile Home

Lived There

Yrs.(Required)

Months(Required)

Cell Phone Number(Required)

Other Phone Number

Email Address Business(Required)

Email Address Personal

Name and Address of Landlord or Mortgage Holder(Required)

Phone Number of Landlord or Mortgage Holder Area Code(Required)

Rent or Mortgage Pmt.(Required)

Previous Address (if less than 2yrs at present address) (Number, Street, Apt)

Previous Address City

Previous Address State

Previous Address Zip

Lived There # Yrs.

Level of Education(Required)

4 Year College Grad

2 Year College Grad

Special Training

Some College

High School Grad

Yes

Current Employer Name(Required)

Current Employer Address(Required)

Applicants Occupation(Required)

Work Phone Number

Gross Monthly Salary(Required)

Other Income $

Previous Employers Name (If less than 5 years at current employer)

Previous Employers City

Previous Employers State

Name of Bank(Required)

Type of Bank Account(Required)

Checking & Savings

Checking Only

Savings Only

No Account

Have I Ever Had a Car or Other Merchandise Repossessed?(Required)

Yes

If yes, when?

Month of Repossession

Year of Repossession

Have I Ever Filed Bankruptcy?(Required)

Yes

Month of Bankruptcy

Year of Bankruptcy

Current Credit

Current/Previous Cars Financed by or Leased through

Creditor 1

Creditors Name/City/State #1

Date Opened #1

Monthly Payment Amount #1

Unpaid Balance #1

Creditor 2

Creditors Name/City/State #2

Date Opened #2

Monthly Payment Amount #2

Unpaid Balance #2

Other Credit

Other Creditors

Creditors Name/City/State #3

Date Opened #3

Monthly Payment Amount #3

Unpaid Balance #3

Creditors Name/City/State #4

Date Opened #4

Monthly Payment Amount #4

Unpaid Balance #4

Name and Address of Applicant’s Nearest Relatives/Friends Not in Household

Name of Relative #1

Phone Number Relative #1

Relationship Relative #1

Name of Relative #2

Phone Number Relative #2

Relationship Relative #2

Name of Relative #3

Phone Number Relative #3

Relationship Relative #3

Name of Relative #4

Phone Number Relative #4

Relationship Relative #4

I acknowledge I have read side A and side B of this form, including the state specific disclosures.

For the purpose of securing credit from you, I certify that the above information is true and complete to the best of my knowledge. I further certify that I have attained the age of majority. I authorize you to check my credit and employment history and to provide and/or obtain information about credit experience with me. I agree that you, your affiliates, agents and service providers may monitor and record telephone calls regarding my account to assure the quality of your service or for other reasons. I also expressly consent and agree to you, your affiliates, agents and service providers using written, electronic or verbal means to contact me. This consent includes, but is not limited to, contact by manual calling methods, prerecorded or artificial voice messages, text messages, emails and/or automatic telephone dialing systems. I agree you, your affiliates, agents and service providers may do so using any e-mail address or any telephone number I provide, now or in the future, including a number for a cellular phone or other wireless device, regardless of whether I incur charges as a result.

Signature(Required)

Date(Required)

I intend to apply for joint credit

Signature

Are you a Wisconsin resident?(Required)

The following section is for Wisconsin residents only.

Non-applicant spouse information

Information

Married

Unmarried

Seperated

Last Name

First Name

Middle Name

suffix

jr.

sr.

Mailing Address (City, State, Zip Code)

I have applied for credit from (dealer)

For the purpose of purchasing (description of vehicle)

The Obligation

is not

Being incurred in the interest of my marriage or family.

Signature

CALIFORNIA RESIDENT

Applicant, if married, may apply for a separate account.

MAINE RESIDENT

If your credit application is approved and you finance the purchase of your motor vehicle through Creditor, you will be required to insure the vehicle against loss or damage. Creditor requires collision coverage and comprehensive coverage or fire and theft coverage. In addition, if this application is for a lease, Creditor will also require you to obtain liability insurance.

You have the option to select an agent or broker of your choice, whether or not affiliated with Creditor. Obtaining insurance from a particular agent or broker does not affect credit decisions by Creditor, unless the insurance product selected violates the terms of your contract for the purchase or lease of the motor vehicle.

NEW HAMPSHIRE RESIDENT

I acknowledge receipt of a true and completely filled in copy of this credit application form at the time of signing. If you are applying for a balloon payment contract, you are entitled, if you ask, to receive a written estimate of the monthly payment amount for refinancing the balloon payment in accord with the creditor’s existing refinance programs. You would be entitled to receive the estimate before you enter into the balloon payment contract. A balloon payment contract is an installment sale contract with a final scheduled payment that is at least twice the amount of one of the earlier scheduled equal periodic installment payments.

NEW YORK RESIDENT

A Consumer Report may be requested in connection with this application for credit or any future update, renewal, or extension of such credit. Upon request, you will be informed whether or not a consumer report was requested. If a report was requested, you will be informed of the name and address of the consumer agency that furnished the report.

OHIO RESIDENT

The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy 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 RESIDENT

A Credit Report may be requested in connection with this application for credit. Vehicle insurance may be obtained from a person of your choice.

TENNESSEE RESIDENT

You must maintain insurance as described in the contract. You may purchase this insurance from anyone you choose. Your choice of insurance provider will not affect the credit decision or credit terms in any way, except that Creditor may impose reasonable standards for the creditworthiness of the insurer or the scope of coverage chosen.

VERMONT RESIDENT

By signing this credit application, Applicant consents to You obtaining a credit report for the purposes of evaluating this application and to obtain subsequent credit reports, in connection with this transaction, for the purpose of reviewing the account, taking collection action on the account or for any other legitimate purpose associated with the account.