Secure Loan Application

Primary 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 2 years, please enter your prior address:

Which accounts are in your name:

Utilities Savings Checking Phone

Who do you bank with? For how long?

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:

Employer contact number:

Occupation:

Employment Status:

Time on Job:

Years Months

If you have been employed at your current job less than 2 years, please list your previous employer, time employed and contact number:

How often are you paid:

How much per paycheck:

(numbers only)

Other Income:

per month

Other Income Source/Type:

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:

Desired Monthly Payment

Desired Monthly Payment:

Paying more can be a good thing! Paying more per month can save you thousands of dollars on interest and shave years off of your finance term! We try to keep our customers on the shortest finance terms possible, let us know how much you could possibly do per month and still be totally comfortable!

Down Payment

Down Payment Amount:

The more money you put down the better for you! Lower your monthly payments significantly, shorten your finance term, save on interest & gain more equity in your investment! Less money down is okay, just expect higher payments and potential negative equity in the future.

Trade-In Details

Trade-in Make:

Trade-in Model:

Trade-in Year:

Trade-in Mileage:

Additional Comments:

Thank You

Thank you for your application and the opportunity to earn your business! Our finance specialist will be contacting you shortly! Proof of income (most recent check stubs or Taxes) and proof of residence (Utility bills, cell phone bills or official mail with your name and address listed) may be needed to successfully secure financing! An image or copy of each applicant's Driver's licence/ID is required. To expedite the process, go ahead and send clear images or copies of everything listed above to our Email: ! If you have any questions, concerns or need help with your application please call, (334) 347-1234. We're always happy to help!! Thank you! Rucker Auto & Cycle Sales Finance Dept.

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 2 years, please enter your prior address:

Which accounts are in your name:

Utilities Savings Checking Phone

Who do you bank with? For how long?

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:

Employer contact number:

Occupation:

Employment Status:

Time on Job:

Years Months

If you have been employed at your current job less than 2 years, please list your previous employer, time employed and contact number:

How often are you paid:

How much per paycheck:

(numbers only)

Other Income:

per month

Other Income Source/Type:

Consent:

Desired Monthly Payment

Desired Monthly Payment:

Trade-In Details

Thank You

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.

Rucker Auto & Cycle SalesSecure Loan Application

Primary Borrower Information

Personal

Employment

Vehicle Information

Desired Monthly Payment

Down Payment

Trade-In Details

Co-borrower Information

Personal

Employment

Desired Monthly Payment

Trade-In Details

Rucker Auto & Cycle Sales
Secure Loan Application