| You are hoping to buy: |
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Enter the Make and Model you would prefer: |
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OR, Provide a general description of the vehicle you're looking for: |
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| Social
Security # |
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| Name: |
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| Address: |
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| Apt.
No. |
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| City: |
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| State: |
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| Postal/Zip
code: |
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| E-mail: |
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| Phone: |
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| All
of the above fields must be completed. Please enter your email and
phone number carefully. Your email address should be complete, as in
yourname@infi.net or myname@aol.com |
| Would you
like additional information about leasing opportunities? |
Yes No
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Do you plan
to trade in your vehicle?
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Yes No Not Sure Yet |
| If Yes,
trade-in information: |
Year
Make
Model
Mileage |
Do you plan
an additional down payment?
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Yes No
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If yes,
approximately how much?
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$ |
| Click the
appropriate circle for the type of application you are making:
|
Individual Credit
Applying for credit in your own name and relying on
your own income or assets and not the income or assets of another
person as the basis for repayment of the credit
requested. Joint Credit
Applying for joint credit with another person. What is
your relationship to the other party?
What is the name of the other party?
What is their social security number?
Individual Plus
Credit
Applying for credit in your own name but relying on
income from alimony, child support, or separate maintenance or on
the income or assets of another person as a basis for repayment of
the credit requested. |
| Birthday: (MM/DD/YY) |
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| At your
current address do you: |
Own Rent
Live with your
family
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| Amount of
rent or mortgage payment (if any) |
$
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| Length of
time at current address: |
Years
Months |
| Closest adult relative not living
with you:
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| Name: |
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| Relationship to you: |
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| Address,
City, State, Zip: |
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| Daytime
Phone: |
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| Your
Employer: |
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| Occupation: |
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| Business
phone: |
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| Length of
time on job: |
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| Annual Gross
Income: |
$
(Alimony, child support, or separate
maintenance income need not be revealed if you do not wish to have
it considered as a basis for repaying the obligation.)
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| Total time
with current employer: |
Years Months
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| Military
Rank: |
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I have read the Customer Choice Notice below and understand it thoroughly.
By clicking the "submit'' button below, you certify that the
information you've provided is complete and true. You also
authorize the dealership to submit this information you selected for the purpose of investigating your credit and
employment history, obtaining credit reports and releasing
information about creditors experience with you.
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