Secure Loan Application

Primary Borrower Information

Loan Information

Desired Loan Amount:

Desired Maximum Monthly Payment:

Personal

First Name:

Middle Initial:

Last Name:

Date Of Birth (MM/DD/YYYY):

Social Security Number:

- -

Home Phone:

Cell Phone:

Work Phone:

Email:

Address:

City:

State:

Zip Code:

County:

Residence Type:

Own Rent Live with Relative

At Residence Since (MM/YYYY):

Mortgage/Rent Payment:

per month

If you have lived at your current residence less than 5 years, please enter your complete (address,city,state,zip) prior address:

How long were you at your previous residence:

Years Months

Which accounts are in your name:

Utilities Savings Checking Phone

Drivers License Information:

Drivers License Number:

State Issued In:

Drivers License Expiration (MM/DD/YYYY):

Employment (If current is less then 5 years):

Employer Name:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Business Phone:

Occupation:

Start Hire Date: (MM/DD/YYYY):

Income:

per month

Select Employment / Income Type:

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repayment of this obligation

Additional Income (and put a $ if possible):

per month

Source Of Additional Income:

Previous Employment

Employer Name:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Business Phone:

Previous Job Title:

Income:

per month

Length of Previous Job:

Years Months

Select Employment / Income Type:

Comments:

Vehicle Information

Stock # / Unit

Vehicle Make:

Vehicle Model:

Vehicle Year:

Down Payment

Down Payment Amount:

Trade-In Details

Trade-In Make:

Trade-In Model:

Trade-in Year:

Trade-in Mileage:

Additional Trade-In Details:

Relative Reference (Nearest Relative Not Living With You)

Name (First & Last)

Address:

City:

State:

Zip Code:

Phone Number:

Relationship:

Co-borrower Information

Loan Information

Desired Loan Amount:

Desired Maximum Monthly Payment:

Personal

First Name:

Middle Initial:

Last Name:

Date Of Birth (MM/DD/YYYY):

Social Security Number:

- -

Home Phone:

Cell Phone:

Work Phone:

Email:

Address:

City:

State:

Zip Code:

County:

Residence Type:

Own Rent Live with Relative

At Residence Since (MM/YYYY):

Mortgage/Rent Payment:

per month

If you have lived at your current residence less than 5 years, please enter your complete (address,city,state,zip) prior address:

How long were you at your previous residence:

Years Months

Relationship To Applicant:

Which accounts are in your name:

Utilities Savings Checking Phone

Drivers License Information:

Drivers License Number:

State Issued In:

Drivers License Expiration (MM/DD/YYYY):

Employment (If current is less then 5 years):

Employer Name:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Business Phone:

Occupation:

Start Hire Date: (MM/DD/YYYY):

Income:

per month

Select Employment / Income Type:

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repayment of this obligation

Additional Income (and put a $ if possible):

per month

Source Of Additional Income:

Previous Employment

Employer Name:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Business Phone:

Previous Job Title:

Income:

per month

Length of Previous Job:

Years Months

Select Employment / Income Type:

Comments:

Vehicle Information

Stock # / Unit

Vehicle Make:

Vehicle Model:

Vehicle Year:

Down Payment

Down Payment Amount:

Trade-In Details

Trade-In Make:

Trade-In Model:

Trade-in Year:

Trade-in Mileage:

Additional Trade-In Details:

Relative Reference (Nearest Relative Not Living With You)

Name (First & Last)

Address:

City:

State:

Zip Code:

Phone Number:

Relationship:

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.

RPM Auto SalesSecure Loan Application

Primary Borrower Information

Loan Information

Personal

Drivers License Information:

Employment (If current is less then 5 years):

Previous Employment

Vehicle Information

Down Payment

Trade-In Details

Relative Reference (Nearest Relative Not Living With You)

Co-borrower Information

Loan Information

Personal

Drivers License Information:

Employment (If current is less then 5 years):

Previous Employment

Vehicle Information

Down Payment

Trade-In Details

Relative Reference (Nearest Relative Not Living With You)

RPM Auto Sales
Secure Loan Application