Secure Loan Application

E & M AUTO SALES
Secure Loan Application

Primary Borrower Information

Loan Information

Desired Loan Amount:

Desired Monthly Payment:

Down Payment Amount:

Applicant Information

Last Name:

First Name:

Middle Initial:

Social Security#:

- -

Birth Date:

/ /

Address:

P.O Box:

City:

State:

Zip:

Home Phone*:

Cell Phone*:

Residential Status:

Homeowner Rent Family Other

Time at Address:

Years Months

Rent/Mtg Pmt.$

Lien Holder:

Email Address:

Driver's License No:

Driver's License State:

Drivers License Expiration Date:

Time at Previous Address:

Years Months

Previous Full Address (if less than 2 years at current address)

P.O Box:

City:

State:

Zip:

Employer Name:

Employment Type:

Employed Unemployed Self Employed(no W2) Military Retired Student Other

Salary:

Salary Type:

Weekly Bi-Weekly Monthly Annualy

Occupation:

Length of Employment:

Years Months

Work Phone ( must be land line)*:

Previous Employer Name (if less than 2 years at current employer)

Previous Employer Type:

Employed Unemployed Self Employed(no W2) Military Retired Student Other

Previous Occupation:

Length of Employment:

Years Months

Previous Work Phone Number ( must be land line):

Other Income(Monthly):

Source of Other Income:

Have you filed bankruptcy in the last 5 years:

Are you a US Citizen:

Comments :

Vehicle Information

Vehicle Year:

Vehicle Make:

Vehicle Model:

Vehicle Mileage:

Vehicle Stock Number:

Trade-In Details

Trade-in Year:

Trade-In Make:

Trade-In Model:

Trade Trim:

Trade-in Mileage:

Trade-In Vin #:

Lienholder:

Payoff Amount:

Trade-In loan account number:

Signature of Applicant / Joint Applicant

Applicant's Signature

write your initials

Date:

/ /

Consent

Consent:

I consent that by submitting this application, I am authorizing this dealership to check my credit.

Co-borrower Information

Loan Information

Desired Loan Amount:

Desired Monthly Payment:

Down Payment Amount:

Applicant Information

Last Name:

First Name:

Middle Initial:

Social Security#:

- -

Birth Date:

/ /

Address:

P.O Box:

City:

State:

Zip:

Home Phone*:

Cell Phone*:

Residential Status:

Homeowner Rent Family Other

Time at Address:

Years Months

Rent/Mtg Pmt.$

Lien Holder:

Email Address:

Driver's License No:

Driver's License State:

Drivers License Expiration Date:

Time at Previous Address:

Years Months

Previous Full Address (if less than 2 years at current address)

P.O Box:

City:

State:

Zip:

Employer Name:

Employment Type:

Employed Unemployed Self Employed(no W2) Military Retired Student Other

Salary:

Salary Type:

Weekly Bi-Weekly Monthly Annualy

Occupation:

Length of Employment:

Years Months

Work Phone ( must be land line)*:

Previous Employer Name (if less than 2 years at current employer)

Previous Employer Type:

Employed Unemployed Self Employed(no W2) Military Retired Student Other

Previous Occupation:

Length of Employment:

Years Months

Previous Work Phone Number ( must be land line):

Other Income(Monthly):

Source of Other Income:

Have you filed bankruptcy in the last 5 years:

Are you a US Citizen:

Comments :

Vehicle Information

Vehicle Year:

Vehicle Make:

Vehicle Model:

Vehicle Mileage:

Vehicle Stock Number:

Trade-In Details

Trade-in Year:

Trade-In Make:

Trade-In Model:

Trade Trim:

Trade-in Mileage:

Trade-In Vin #:

Lienholder:

Payoff Amount:

Trade-In loan account number:

Signature of Applicant / Joint Applicant

Applicant's Signature

write your initials

Date:

/ /

Consent

Consent:

I consent that by submitting this application, I am authorizing this dealership to check my credit.

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.

E & M AUTO SALESSecure Loan Application

Primary Borrower Information

Loan Information

Applicant Information

Vehicle Information

Trade-In Details

Signature of Applicant / Joint Applicant

Consent

Co-borrower Information

Loan Information

Applicant Information

Vehicle Information

Trade-In Details

Signature of Applicant / Joint Applicant

Consent

E & M AUTO SALES
Secure Loan Application