Secure Loan Application

Primary Borrower Information

Personal

Full Legal Name:

Name You Go By:

Birthday:

/ /

Address:

City:

State:

Zip:

County:

How long at Current Residence:

Home Phone:

Message#:

- -

Cell Phone:

Email:

Social Security Number:

- -

Drivers Lic. #:

Drivers Lic. State:

(CA,NY, etc.)

Number of Children:

Ages of Children:

Landlord/Mortgage Holder Name:

Landlord /Mortgage Holder Phone:

Mortgage/Rent Payment:

per month

Security Deposit Amount:

Previous Address:

How Long At Previous Address:

Other Cities and States Where You Have Lived:

City/State/Date Range

Employment

Employer Name:

Position:

Employer Address:

Shift and Hours Worked:

Hire Date:

/ /

Business Phone:

Supervisor Name:

Supervisor Phone Number:

How often are you paid:

Day of Next Payday:

Date of Next Payday:

/ /

How much per paycheck:

(numbers only)

Previous Employer:

Years Employed:

Years

Other Income:

per month

Source of other Income:

Bank Information

Bank Name:

Branch:

Phone Number:

Checking Account #:

Savings Account #:

Insurance Information

Company:

Insurance Agent:

Address:

City/State/Zip

Agent's Phone #:

Coverage:

Full Liability

Deductible Amount:

Spouse or Co-Applicant Information:

Spouse or Co-Buyer's Legal Name:

Name You Go By:

Birth date:

/ /

Home Address:

City:

State:

Zip Code:

County:

How long at this Address:

Home Phone:

Message #:

- -

Cell Phone #:

Email Address:

Social Security Number:

- -

Drivers License #:

Drivers License State:

(CA,NY, etc.)

Number of Children:

Ages of Children:

Landlord/Mortgage Holder Name:

Landlord /Mortgage Holder Phone:

Mortgage/Rent Payment:

Security Deposit:

Previous Address:

How long at previous Address:

Other Cities and States Where You Have Lived:

City/State/Date Range

Co-Borrower Employment

Employer Name:

Position:

Employer Address:

Shift and Hours Worked:

Hire Date:

/ /

Business Phone:

Supervisor Name:

Supervisor Phone:

How often are you paid:

Day of Next Payday:

Date of Next Payday:

/ /

How much per paycheck:

(numbers only)

Previous Employer:

Time at Previous Employer:

Other Income:

per month

Source of Other Income:

Creditors

Creditor #1 Name:

Address

City/State/Zip

Contact Person:

Telephone #:

Date Account Open:

/ /

Original Amt $:

Present Amt $:

Is Account Active:

Yes No

Type of Payments:

Amount of Pmt $:

Is Account Current:

Yes No

If No, Why:

Creditor #2 Name:

Address

City/State/Zip

Contact Person:

Telephone #:

Date Account Open:

/ /

Original Amt $:

Present Amt $:

Is Account Active:

Yes No

Type of Payments:

Amount of Pmt $:

Is Account Current:

If No, Why:

Reference Information: 2 Relatives and 2 Friends (Must have Phone & Address)

Ref #1 Name:

Address:

City/State/Zip

Telephone #:

Relationship:

How Long Known:

Employer:

Emp. Phone #:

May We Call Them:

Yes No

If No, Why:

Ref #2 Name:

Address:

City/State/Zip

Telephone #:

Relationship:

How Long Known:

Employer:

Emp. Phone #:

May We Call Them:

Yes No

If No, Why:

Ref #3 Name:

Address:

City/State/Zip:

Telephone #:

Relationship:

How Long Known:

Employer:

Emp. Phone #:

May We Call Them:

Yes No

If No, Why:

Ref #4 Name:

Address:

City/State/Zip:

Telephone #:

Relationship:

How Long Known:

Employer:

Emp. Phone #:

May We Call Them:

Yes No

If No, Why:

Legal Information

Have you had a judgment against you within the last 5 years:

Yes No

If Yes, explain:

Have you had a charge-off or repossession within the last 5 years:

Yes No

If Yes, explain:

Are you in the process of filing or considering filing bankruptcy:

Yes No

If Yes, explain:

Consent:

I/We certify these statements as true, complete and made for the purpose of obtaining credit. You are authorized to inquire and receive information you deem necessary to determine my/our credit worthiness and to answer questions about you credit experience with me/us. I/We have valid driver licenses. If I/We give false information which allows me/us to qualify of a Kar Mart Limited Inc. loan where I/We otherwise would not, I/We consent and agree that the cash down payment and any trade-in will be forfeited and the newly purchased vehicle will be returned to and restocked by Kar Mart Limited Inc. By Checking this box, you authorize us to obtain consumer credit report, call references and check job history to apply for credit with this us. Please print and date this application.

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.

Kar Mart
Secure Loan Application

Primary Borrower Information

Personal

Employment

Bank Information

Insurance Information

Spouse or Co-Applicant Information:

Co-Borrower Employment

Creditors

Reference Information: 2 Relatives and 2 Friends (Must have Phone & Address)

Legal Information

Consent:

Co-borrower Information

Kar MartSecure Loan Application

Primary Borrower Information

Personal

Employment

Bank Information

Insurance Information

Spouse or Co-Applicant Information:

Co-Borrower Employment

Creditors

Reference Information: 2 Relatives and 2 Friends (Must have Phone & Address)

Legal Information

Consent:

Co-borrower Information

Kar Mart
Secure Loan Application