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Secure Loan Application


Loan Information
Desired Loan Amount:
Desired Monthly Payment:
First Name:
Middle Initial:
Last Name:
Zip Code:
Daytime Phone:
Evening Phone:
Social Security Number:
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):
Employer Name:
Employer Address:
Employer City:
Employer State:
Employer Zip:
Business Phone:
Employment Status:
Time On Job (Years):
Time On Job (Months):
How often are you paid:
How much per paycheck:
Other Income per month:
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:
Down Payment
Down Payment Amount:
Trade-In Details
Trade-in Make:
Trade-in Model:
Trade-in Year:
Trade-in Mileage:
Additional Comments:
By submitting this application, I am applying for credit with this dealership or a designated financing source, I certify that all information herein is true and complete, and I certify that I am the person named above. I authorize this dealership and any potential financing source to retain this application, to check and verify my credit, employment, and salary history. By using the dealers website, I authorize them to provide reports on the status of my credit application, including information concerning whether I pre-qualify for a loan, which lender's loan offer (if any) I choose to accept, whether my application for credit is denied, and whether I accept a loan from the specified lender.

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