Employment Information

Name of Current Employer:
Current Employer Address:
Current Employer City:
Current Employer State & Zip Code:	Zip:
Current Employer Phone Number:
How Long at this Job?
Name of Previous Employer:
Previous Employer Address:
Previous Employer City:
Previous Employer State & Zip Code:	Zip:
Previous Employer Phone Number:
How Long at Previous Employer?

Banking Information

*Name of your Main Bank:
*Bank Account Type:	Please Select Checking Savings
*Balance of Account

Relatives

Name of Nearest Relative Not  Living With You:
Relatives Address:
Relatives City:
Relatives State &  Zip Code:	Zip:
Relatives Phone Number:

Finances

Monthly Income:
Additional Source of Income:
Additional Monthly Income:
Rent or Mortgage?	Please Select Rent Mortgage
Landlord's or Mortgage Company  Name
Monthly Amount of Rent/Mortgage
If Mortgage, List Original Amount:
Current Balance of Mortgage:
List the Names of Banks, Finance  Companies and all to whom Indebted  and the balance owed on each:	Name: Balance:  Name: Balance:  Name: Balance:  Name: Balance:  Name: Balance:  Name: Balance:

Vehicle Information

Choose the type of vehicle you are interested in purchasing:	Please Select Car Truck SUV Mini-Van Other
If you are interested in a vehicle you've seen in our inventory list, please enter the stock number:
Do you have a vehicle you are interested in trading in?	Please Select Yes No
If you are trading in, please specify the following information of the vehicle to be traded:	Year:     Make:  Model:   Mileage:
Specify the amount owed on your trade:
Besides the trade, enter the amount of money you are intending to put down on this purchase:

Authorization

I AUTHORIZE THE BANK TO MAKE WHATEVER CREDIT INQUIRIES IT DEEMS NECESSARY IN CONNECTION WITH THIS APPLICATION, OR IN THE COURSE OF REVIEW OR COLLECTION OF ANY CREDIT EXTENDED IN RELIANCE ON THE APPLICATION. I AUTHORIZE AND DIRECT ANY PERSON OR CONSUMER REPORTING AGENCY TO COMPILE AND FURNISH THE BANK ANY INFORMATION IT MAY HAVE OR OBTAIN RESPONSE TO SUCH CREDIT INQUIRIES AND AGREE THAT SAME SHALL REMAIN YOUR PROPERTY WHETHER OR NOT CREDIT IS EXTENDED. YOU ARE ALSO AUTHORIZED TO ANSWER QUESTIONS ABOUT YOUR CREDIT EXPERIENCE WITH ME.

I Agree (Must agree to authorization and check this box to submit Application)