Secure Loan Application

JR's Auto Connection
Secure Loan Application

Primary Borrower Information

Personal

Name:

Address:

City/State/Zip:

Cell Phone:

Social Security Number:

- -

Birthday:

/ /

Email:

Employment

Employer Name:

Employer Address:

Position/Title:

Yrs. Employed:

Wages:

Work Phone:

Housing Costs & Other Income

Rent/Mortgage $ :

Income Source:

List alimony,child support or separate maintance income only if you want it considered. You will be required to substantiate any other income listed.

Payment Arrangements

Loan Amount Requested:

For Auto Loan Applicants

Year:

Mileage:

Make:

Model:

Refinance or Purchase:

Refinance or Purchase

Loan Agreement

Signature:

Write Your Initials

Date

/ /

Additional Loan Notes

Additional Loan Notes:

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.

JR's Auto ConnectionSecure Loan Application

Primary Borrower Information

Personal

Employment

Housing Costs & Other Income

Payment Arrangements

For Auto Loan Applicants

Loan Agreement

Additional Loan Notes

Co-borrower Information

Personal

Employment

Housing Costs & Other Income

Payment Arrangements

For Auto Loan Applicants

Loan Agreement

Additional Loan Notes

JR's Auto Connection
Secure Loan Application