Secure Loan Application

Primary Borrower Information

Loan Information

Desired Loan Amount:

Desired Monthly Payment:

Personal

First Name:

Middle Initial:

Last Name:

Address:

City:

State:

Zip:

Daytime Phone:

Evening Phone:

Email:

Social Security Number:

- -

Date of Birth:

/ /

Mortgage/Rent Payment:

per month

Residence Type:

How long at the Residence?:

Years Months

Do you have a Checking or Savings account:

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

How long did you live at prior residence?:

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:

Hire Date :

End Date:

Income Type:

Gross Monthly Income:

Source of other Income:

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

Additional Income:

Hire Date:

/ /

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.

If Current Job is less than 2 years please input Previous Employment

Employer Name:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Business Phone:

Occupation:

Hire Date:

End Date

Salary:

per month

Vehicle Information

Vehicle Make:

Vehicle Model:

Vehicle Year:

Vehicle Mileage:

Down Payment

Down Payment Amount:

Trade-In Details

Vin #:

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

Amount Owed:

Trade-In Make:

Trade-In Model:

Trade-in Year:

Trade-in Mileage:

Additional Comments:

Co-borrower Information

Loan Information

Desired Loan Amount:

Desired Monthly Payment:

Personal

First Name:

Middle Initial:

Last Name:

Address:

City:

State:

Zip:

Daytime Phone:

Evening Phone:

Email:

Social Security Number:

- -

Date of Birth:

/ /

Mortgage/Rent Payment:

per month

Residence Type:

How long at the Residence?:

Years Months

Do you have a Checking or Savings account:

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

How long did you live at prior residence?:

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:

Hire Date :

End Date:

Income Type:

Gross Monthly Income:

Source of other Income:

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

Additional Income:

Hire Date:

/ /

Consent:

If Current Job is less than 2 years please input Previous Employment

Employer Name:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Business Phone:

Occupation:

Hire Date:

End Date

Salary:

per month

Vehicle Information

Vehicle Make:

Vehicle Model:

Vehicle Year:

Vehicle Mileage:

Down Payment

Down Payment Amount:

Trade-In Details

Vin #:

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

Amount Owed:

Trade-In Make:

Trade-In Model:

Trade-in Year:

Trade-in Mileage:

Additional Comments:

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.

Roddy MotorsSecure Loan Application

Primary Borrower Information

Loan Information

Personal

Employment

If Current Job is less than 2 years please input Previous Employment

Vehicle Information

Down Payment

Trade-In Details

Co-borrower Information

Loan Information

Personal

Employment

If Current Job is less than 2 years please input Previous Employment

Vehicle Information

Down Payment

Trade-In Details

Roddy Motors
Secure Loan Application