Secure Loan Application

Primary Borrower Information

Loan Information

Down Payment Amount:

(Minimum $1,000)

Desired Monthly Payment:

Credit Score:

Have you had a vehicle repossessed:

Yes No

If Yes, how many:

If yes, when:

Dealership or finance company that repossessed the vehicle:

Personal

First Name:

Middle Initial:

Last Name:

Address:

City:

State:

Zip:

Daytime Phone:

Evening Phone:

Fax:

- -

Email:

Social Security Number:

- -

Birthday:

/ /

Mortgage/Rent Payment:

per month

Residence Type:

Time at Residence:

Years

Time at Residence:

Months

If you have lived at your current residence less than 5 years, please enter your prior address:

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)

Employment

Employer Name:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Business Phone:

Occupation:

Employment Status:

Time On Job:

Years

Time On Job:

Months

How often are you paid:

How much per paycheck:

(numbers only)

Other Income:

per month

Vehicle Information

Vehicle Make:

Vehicle Model:

Vehicle Year:

Vehicle Mileage:

Trade-In Details

Trade-in Make:

Trade-in Model:

Trade-in Year:

Trade-in Mileage:

Additional Comments:

Consent

Consent:

Co-borrower Information

Personal

First Name:

Middle Initial:

Last Name:

Address:

City:

State:

Zip:

Daytime Phone:

Evening Phone:

Fax:

- -

Email:

Social Security Number:

- -

Birthday:

/ /

Mortgage/Rent Payment:

per month

Residence Type:

Time at Residence:

Years

Time at Residence:

Months

If you have lived at your current residence less than 5 years, please enter your prior address:

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)

Employment

Employer Name:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Business Phone:

Occupation:

Employment Status:

Time On Job:

Years

Time On Job:

Months

How often are you paid:

How much per paycheck:

(numbers only)

Other Income:

per month

Consent

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.

FPAASecure Loan Application

Primary Borrower Information

Loan Information

Personal

Employment

Vehicle Information

Trade-In Details

Consent

Co-borrower Information

Personal

Employment

Consent

FPAA
Secure Loan Application