Secure Loan Application

Co-borrower Information

Personal

Last Name:

First Name:

Middle Initial:

Birthday:

/ /

Social Security Number:

- -

Mailing Address:

City:

State:

Zip:

Time at Residence:

Years

Time at Residence:

Months

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

Landlord/Mortgage Company Name:

Mortgage/Rent Payment:

per month

Phone Number:

Address:

Do you rent or own?

Rent Own

Utilities in Whose Name:

Home Phone:

Cell Phone:

Email:

Number of dependents:

Average Monthly Utilities Expense:

Have you ever filed bankruptcy?

Yes No

If Yes, When:

/ /

Employment

Employer Name:

Hire Date:

/ /

Position:

Pay Day:

Net Salary:

per month

Hours Worked per Week:

Business Phone:

Supervisor Name:

How Often Do You Get Paid?

How often are you paid:

If you have been employed at your current job less than 2 years, please enter your previous employment history:

Other Income:

per month

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

Total Income:

per month

References

Name:

Address:

Phone Number:

Relationship:

Name:

Address:

Phone Number:

Relationship:

Name:

Address:

Phone Number:

Relationship:

Name:

Address:

Phone Number:

Relationship:

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.

Advance Auto Sales
Secure Loan Application

Primary Borrower Information

Loan Information

Personal

Employment

References

Co-borrower Information

Personal

Employment

References

Advance Auto SalesSecure Loan Application

Primary Borrower Information

Loan Information

Personal

Employment

References

Co-borrower Information

Personal

Employment

References

Advance Auto Sales
Secure Loan Application