Secure Loan Application

Primary Borrower Information

Personal

Full Name (First,Middle,Last):

Nickname:

Birthday:

/ /

Social Security Number:

- -

Marital Status:

Number of Dependents:

Ages of Dependents:

Email:

Cell Phone:

Home Phone:

Present Address:

City:

State:

Zip:

How Long at Address:

Landlord/Mortgage Company Name:

Phone Number:

Do you rent or own?

Rent Own

Mortgage/Rent Payment:

per month

Previous Address:

(if current is less than 2 years)

Previous City:

Previous State:

Previous Zip:

Time At Previous Address:

Have you ever filed for bankruptcy? (if yes please explain)

Have you ever had a repossession? (if yes please explain):

Employment

Employer Name:

Employer Address:

Business Phone:

Time On Job:

Supervisor:

Occupation:

How Often Do You Get Paid?

How much per paycheck:

Net Income

Previous Employer Name:

Time at Previous Employer:

References

Name:

Address:

City:

State:

Zip:

Phone Number:

Relationship:

Name:

Address:

City:

State:

Zip:

Phone Number:

Relationship:

Name:

Address:

City:

State:

Zip:

Phone Number:

Relationship:

Name:

Address:

City:

State:

Zip:

Phone Number:

Relationship:

Credit References

Creditor Name:

Phone Number:

Type of Loan:

Balance:

Monthly Payment:

Creditor Name:

Phone Number:

Type of Loan:

Balance:

Monthly Payment:

Current Vehicle Details

Make/Model/Year:

Who Financed:

Is Vehicle Title in your name:

Yes No

Payment Amount:

Amount still owed:

Is this a trade-in:

Yes No

Insurance Company:

Coverage Type:

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.

Co-borrower Information

Personal

Full Name (First,Middle,Last):

Nickname:

Birthday:

/ /

Social Security Number:

- -

Marital Status:

Number of Dependents:

Ages of Dependents:

Email:

Cell Phone:

Home Phone:

Present Address:

City:

State:

Zip:

How Long at Address:

Landlord/Mortgage Company Name:

Phone Number:

Do you rent or own?

Rent Own

Mortgage/Rent Payment:

per month

Previous Address:

(if current is less than 2 years)

Previous City:

Previous State:

Previous Zip:

Time At Previous Address:

Have you ever filed for bankruptcy? (if yes please explain)

Have you ever had a repossession? (if yes please explain):

Employment

Employer Name:

Employer Address:

Business Phone:

Time On Job:

Supervisor:

Occupation:

How Often Do You Get Paid?

How much per paycheck:

Net Income

Previous Employer Name:

Time at Previous Employer:

G.K.A.C. Car LotSecure Loan Application

Primary Borrower Information

Personal

Employment

References

Credit References

Current Vehicle Details

Co-borrower Information

Personal

Employment

Current Vehicle Details

G.K.A.C. Car Lot
Secure Loan Application