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Credit Application

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GENERAL INFORMATION
First Name
Last Name
Your E-mail
Re-Type Your E-mail
Social Security No.	Ex. 123-45-6789
Birthdate	Ex. 08/14/1969
Address
City
State
Zip Code
Home Phone	Ex. 404-555-1212
Time at Residence
Months
Residence Type
Rent/Mortgage $

PURCHASE FINANCING INFORMATION
Number of Months Desired
Loan Amount Desired
Down Payment
Trade In Vehicle?
Trade In Year
Trade In Make
Trade In Model
Trade In Mileage
Trade In Estimated Payoff Amount $

EMPLOYMENT INFORMATION
Employer
Gross Monthly Income
Occupation
City
State
Zip Code
Work Phone	Ex. 404-555-1212
Time on Job
Months
Other Monthly 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 this obligation.
Total Monthly Income
Comments Which car do you want to buy?
Note Please read and scroll down	If you're a resident of California, Maine, Massachusetts, New York, Ohio, Rhode Island, Vermont, Washington, or Wisconsin, please scroll down to read the notice called for under the law of your state. By submitting this application, you represent that you've read the notice required under the law of your state. CALIFORNIA RESIDENTS: A married applicant may apply for an individual account. MAINE RESIDENTS: Consumer reports (credit reports) may be obtained in connection with this application. If you request, the creditor will inform you: (1) whether or not consumer reports were obtained, and (2) if reports were obtained, the names and addresses of the consumer reporting agencies (credit bureaus) that furnished the reports. You have the right to choose the agent and insurer for the insurance required by this transaction, but the insurer must be approved by the creditor. MASSACHUSETTS RESIDENTS: Massachusetts law prohibits discrimination on the basis of marital status or sexual orientation. NEW YORK RESIDENTS: A consumer credit report may be requested in connection with this application or in connection with updates, renewals, extensions or enforcement of any credit granted as a result of this application. Upon your request, the creditor will inform you whether or not a consumer credit report was requested, and if so, the name and address of the agency that furnished such report. OHIO RESIDENTS: The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law. RHODE ISLAND RESIDENTS: A consumer credit report may be requested in connection with this application. VERMONT RESIDENTS: I authorize the creditor to obtain credit reports on an ongoing basis about me from credit reporting agencies in connection with this extension of credit transaction. The creditor may obtain credit reports about me on an ongoing basis in connection with this extension of credit transaction for any one or more of the following reasons: (1) reviewing the account; (2) increasing the credit line on the account; (3) taking collection action on the account; or, (4) any other legitimate purposes associated with the account. WASHINGTON RESIDENTS: Please advise us if the creditor should investigate your credit references and/or credit history under another name. MARRIED WISCONSIN RESIDENTS: No provision of a marital property agreement, a unilateral settlement agreement under Wis. Stat. §766.59, or a court decree under Wis. Stat. §766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree, or has actual knowledge of the adverse provision.

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