Secure Loan Application

Primary Borrower Information

Loan Information

Desired Loan Amount:

Down Payment:

Desired Monthly Payment:

Vehicle Information

Vehicle Make:

Vehicle Model:

Vehicle Year:

Vehicle Mileage:

Trade-In Details

Vin #:

Found on Driver's Door Jam or Driver's Side corner of the windshield

Trade-In Make:

Trade-In Model:

Trade-in Year:

Trade-in Mileage:

Additional Comments:

Personal

First Name:

Middle Initial:

Last Name:

US Citizen?:

Current Address:

City:

State:

Zip:

Time at Residence:

Years Months

If you have lived at your current residence less than 2 years, please enter your prior address:

Cell Phone:

Daytime Phone:

Evening Phone:

Fax:

- -

Email:

Social Security Number:

- -

Birthday:

/ /

Mortgage/Rent Payment:

per month

Mortgage Balance

Residence Type:

Mortgage/Rent Payment at Previous Address:

Which accounts are in your name:

Utilities Savings Checking Phone(choose all that apply)

Drivers Lic. #:

Drivers Lic. State:

(CA,NY, etc.)

Driver Lic. Issue Date:

Driver Lic. Exp. Date:

(MM/DD/YYYY)

Bank Name:

Branch:

Account Type:

Account Balance:

Employment

Employer Name:

Contact Name:

Contact Phone Number:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Business Phone:

Occupation:

Time on Job:

Years on Job
Months on Job

Gross Salary per Month:

Previous Employment History (if less than 2 years at current employer):

Previous Employer Name:

Contact name:

Phone:

Address:

Time at previous work place:

Gross Monthly Income:

Other Income:

References

Relative # 1 (Not living with you)

Name:

Address:

Home Phone:

Work Phone Number:

Relationship:

Relative # 2 (Not living with you)

Name:

Address:

Home Phone:

Work Phone Number:

Relationship:

Reference (Not a relative)

Name:

Address:

Phone Number:

Consent:

Co-borrower Information

Loan Information

Desired Loan Amount:

Down Payment:

Desired Monthly Payment:

Vehicle Information

Vehicle Make:

Vehicle Model:

Vehicle Year:

Vehicle Mileage:

Trade-In Details

Vin #:

Found on Driver's Door Jam or Driver's Side corner of the windshield

Trade-In Make:

Trade-In Model:

Trade-in Year:

Trade-in Mileage:

Additional Comments:

Personal

First Name:

Middle Initial:

Last Name:

US Citizen?:

Current Address:

City:

State:

Zip:

Time at Residence:

Years Months

If you have lived at your current residence less than 2 years, please enter your prior address:

Cell Phone:

Daytime Phone:

Evening Phone:

Fax:

- -

Email:

Social Security Number:

- -

Birthday:

/ /

Mortgage/Rent Payment:

per month

Mortgage Balance

Residence Type:

Mortgage/Rent Payment at Previous Address:

Which accounts are in your name:

Utilities Savings Checking Phone(choose all that apply)

Drivers Lic. #:

Drivers Lic. State:

(CA,NY, etc.)

Driver Lic. Issue Date:

Driver Lic. Exp. Date:

(MM/DD/YYYY)

Bank Name:

Branch:

Account Type:

Account Balance:

Employment

Employer Name:

Contact Name:

Contact Phone Number:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Business Phone:

Occupation:

Time on Job:

Years on Job
Months on Job

Gross Salary per Month:

Previous Employment History (if less than 2 years at current employer):

Previous Employer Name:

Contact name:

Phone:

Address:

Time at previous work place:

Gross Monthly Income:

Other Income:

References

Relative # 1 (Not living with you)

Name:

Address:

Home Phone:

Work Phone Number:

Relationship:

Relative # 2 (Not living with you)

Name:

Address:

Home Phone:

Work Phone Number:

Relationship:

Reference (Not a relative)

Name:

Address:

Phone Number:

Consent:

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.

LAKESIDE MOTORS, INC.Secure Loan Application

Primary Borrower Information

Loan Information

Vehicle Information

Trade-In Details

Personal

Employment

References

Co-borrower Information

Loan Information

Vehicle Information

Trade-In Details

Personal

Employment

References

LAKESIDE MOTORS, INC.
Secure Loan Application