Secure Loan Application

Affordable Auto Rental & Sales
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 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

Vehicle Information

What Vehicle are you interested in?:

Down Payment

Down Payment Amount:

Desired Monthly Payment:

Trade-In Details

Trade-in Make:

Trade-in Model:

Trade-in Year:

Trade-in Mileage:

Additional Comments:

Debts

Landlord or Mortgage Company Name:

Contact Name:

Contact Phone:

Account No.

2nd Mortgage Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes

Auto Loan #1 Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes No

Auto Loan #2 Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes No

Bank/Credit Union Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes No

Credit Card #1 Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes No

Credit Card #2 Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes No

Alimony/Child Support/Spousal Maintenance Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes No

Other (Garnishments, Etc) Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes No

Are there any other persons obligated on any of the above debts:

Yes No

If Yes, which debts and whom:

Are you a co-maker, co-signer, or guarantor on any other debt:

Yes No

If Yes, what amount, to whom, and for whom:

Have you declared bankruptcy in the last 7 years:

Yes No

Consent

Consent:

This application is correct to the best of my knowledge. I understand that you will retain this application and any other credit information you receive whether or not a loan is approved. Affordable Auto and its assigns are authorized to check my credit and employment history and to answer questions about your credit experience with me. I authorize any person or consumer-reporting agency to complete and furnish to you any information it may have or obtain in response to your credit inquires whenever you make them. I hereby recognize the penalties and defenses resulting from giving a false statement of financial condition and that the giving of false information hereon may be illegal and fraudulent and may be the basis for denying a discharge in bankruptcy. I further state that I am not contemplating a bankruptcy action at the present time and that I have no unpaid judgements or executions or pending legal proceedings against me.

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

Debts

Landlord or Mortgage Company Name:

Contact Name:

Contact Phone:

Account No.

2nd Mortgage Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes

Auto Loan #1 Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes No

Auto Loan #2 Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes No

Bank/Credit Union Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes No

Credit Card #1 Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes No

Credit Card #2 Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes No

Alimony/Child Support/Spousal Maintenance Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes No

Other (Garnishments, Etc) Start Date:

Original Amount:

Current Balance:

Monthly Payment:

Past Due:

Yes No

Are there any other persons obligated on any of the above debts:

Yes No

If Yes, which debts and whom:

Are you a co-maker, co-signer, or guarantor on any other debt:

Yes No

If Yes, what amount, to whom, and for whom:

Have you declared bankruptcy in the last 7 years:

Yes No

Consent

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.

Affordable Auto Rental & SalesSecure Loan Application

Primary Borrower Information

Personal

Employment

Vehicle Information

Down Payment

Trade-In Details

Debts

Consent

Co-borrower Information

Personal

Employment

Debts

Consent

Affordable Auto Rental & Sales
Secure Loan Application