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:

Fax:

- -

Email:

Social Security Number:

- -

Birthday:

/ /

Mortgage/Rent Payment:

per month

Residence Type:

Time at Residence:

Years

Time at Residence:

Months

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:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Business Phone:

Occupation:

Employment Status:

Time On Job:

Years

Time On Job:

Months

How often are you paid:

How much per paycheck:

(numbers only)

Other Income:

per month

Consent:

By submitting your credit application you agree that you: Make the above representations, which are certified correct, to the purpose of securing credit. Authorize us, affiliated entities, and financial institutions to whom we submit your application, (hereinafter “financial institution”) to obtain consumer credit reports and to gather employment histories as necessary and appropriate to determine your creditworthiness. Understand that we or the financial institutions will retain this application whether or not it is approved, and that it is your responsibility to update changes of name, address or employment. You are notified pursuant to the Fair Credit Reporting Act, that your application may be submitted to financial institutions.

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:

City:

State:

Zip:

Daytime Phone:

Evening Phone:

Fax:

- -

Email:

Social Security Number:

- -

Birthday:

/ /

Mortgage/Rent Payment:

per month

Residence Type:

Time at Residence:

Years

Time at Residence:

Months

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:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Business Phone:

Occupation:

Employment Status:

Time On Job:

Years

Time On Job:

Months

How often are you paid:

How much per paycheck:

(numbers only)

Other Income:

per month

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.

Jennifer's Auto SalesSecure Loan Application

Primary Borrower Information

Loan Information

Personal

Employment

Consent:

Vehicle Information

Down Payment

Trade-In Details

Co-borrower Information

Personal

Employment

Consent:

Jennifer's Auto Sales
Secure Loan Application