Titan Auto Sales - Berwick, PA
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Loan Information
Desired Loan Amount:
Desired Monthly Payment:
First Name:
Middle Initial:
Last Name:
Unit/Lot/Apt Number:
Home Phone:
Cell Phone:
Fax: - -
Social Security Number: - -
Birthday: / /
Mortgage/Rent Payment: per month
Living arrangement: Own Rent Family
Time at Residence: Years
Time at Residence: Months
Which accounts are in your name: Utilities Savings Checking Phone
Drivers Lic. #:
Drivers Lic. State: (CA,NY, etc.)
Driver Lic. Exp. Date: (MM/DD/YYYY)
Previous Residence (if less than two years at current residence)
Previous Address:
Previous City:
Previous State:
Previous Zip Code:
Monthly Rent/Mtg Pmt $:
Time at Previous Address:Years
Time at Previous Address:Months
Employer Name:
Employer Address:
Employer City:
Employer State:
Employer Zip:
Business Phone:
Employment Status:
Time On Job: Years
Time on Job:Months
How Often are you Paid?
How much gross income per paycheck(numbers only)
Amount of 2nd gross income per month (if any):
Source of 2nd Income:Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for approval of this obligation
Consent: I agree that by submitting this application, I authorize and give this dealership, as well as any potential financing source this dealership presents this application to, my consent to obtain my credit report from any credit reporting agency used to complete an investigation of my credit.
If Current Job is less than 2 years please input Previous Employment
Previous Employer Name:
Previous Employer Address:
Previous Employer City:
Previous Employer State:
Previous Employer Zip:
Business Phone:
Time on Job:Years
Time on Job:Months
Vehicle you are interested in
Vehicle Make:
Vehicle Model:
Vehicle Year:
Vehicle Mileage:
Down Payment
Down Payment Amount:
Trade-In Details
Trade-In Make:
Trade-In Model:
Trade-in Year:
Trade-in Mileage:
Additional Comments:
Bank Information
Do you have a Bank Account?: Yes No
Bank Name:
Accounts in your name: Checking Saving
Cards in your name: Debit Card Credit Card Pre-paid Debit Card
Please select which method you would like us to contact you (you can select more than one)
lease select which method you would like us to contact you(you can select more then one) By cell phone By e-mail By Home Phone By Work Phone You will contact us

By submitting this application, I certify that all information herein is true and complete. I agree I am providing this information to the dealer identified in this application and acknowledge that my information may be shared pursuant to the dealer’s privacy policy, if applicable. I hereby authorize this dealer, and any financial institution engaged as a service provider by this dealer, to retain this application and to check and verify my credit, employment and salary history. By submitting this application, I acknowledge I am authorizing this dealer to check my credit.

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