Secure Loan Application

Primary Borrower Information

Loan Information

Desired Loan Amount:

Desired Monthly Payment:

Personal

First Name:

Middle Initial:

Last Name:

Address:

If less than 3 years at current address, please enter prior address.

City:

State:

Zip:

Daytime Phone:

Evening Phone:

Fax:

- -

Email:

Social Security Number:

- -

Birthday:

/ /

Mortgage/Rent Payment:

per month

Time at Residence:

Years

Time at Residence:

Months

Residence Type:

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:

If you've been on the job less than 3 years, please provide previous employer.

Employer Address:

Employer City:

Employer State:

Employer Zip:

Business Phone:

Occupation:

Time On Job:

Years

Time On Job:

Months

How much per paycheck:

(numbers only)

Other Income:

per month

Other Income Source:

Consent:

I agree that by submitting this application, I authorize and give this dealership, as well as any potential financing source this dealership presents this application to, my consent to obtain my credit report from any credit reporting agency used to complete an investigation of my credit.

Vehicle Information

Vehicle Make:

Vehicle Model:

Vehicle Year:

Vehicle Mileage:

Down Payment

Down Payment Amount:

Trade-In Details

Trade-in Make:

Trade-in Model:

Trade-in Year:

Trade-in Mileage:

Additional Comments:

Co-borrower Information

Personal

First Name:

Middle Initial:

Last Name:

Address:

If less than 3 years at current address, please enter prior address.

City:

State:

Zip:

Daytime Phone:

Evening Phone:

Fax:

- -

Email:

Social Security Number:

- -

Birthday:

/ /

Mortgage/Rent Payment:

per month

Time at Residence:

Years

Time at Residence:

Months

Residence Type:

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:

If you've been on the job less than 3 years, please provide previous employer.

Employer Address:

Employer City:

Employer State:

Employer Zip:

Business Phone:

Occupation:

Time On Job:

Years

Time On Job:

Months

How much per paycheck:

(numbers only)

Other Income:

per month

Other Income Source:

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.

Auto ExpressSecure Loan Application

Primary Borrower Information

Loan Information

Personal

Employment

Vehicle Information

Down Payment

Trade-In Details

Co-borrower Information

Personal

Employment

Auto Express
Secure Loan Application