Credit Application Form

This is an application for credit with Dealer. You understand there is no agreement between us until we approve your credit application and accept all other required documents for funding.

Payment Information

Applicant Information

Date of Birth  

Co-Applicant Information

Date of Birth  

Other 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.)

Personal References:

(Not in same household)

1.

2.

Optional ACH:(AUTOMATIC WITHDRAWALS)

I (we) hereby authorize lender or any assignee to initiate debit entries to the below-listed account for my monthly payments. This authorization remains in full force and effect until the lender/assignee has received written notification from me (us) in such time and such manner as to afford lender/assignee a reasonable opportunity to act on it. Please allow 10 days for all changes to be effective.
  

***PLEASE ATTACH A VOIDED CHECK OR DEPOSIT SLIP***

  
By signing this application, you promise all information is true and complete. You intend the seller and/or assignee to rely upon this information in deciding whether or not to extend credit to you. You authorize a full investigation and release of your credit record and your employment history. You also authorize the seller and/or assignee to release information about credit experience with them. You consent to receiving autodialed or prerecorded message calls from us or those acting on our behalf at any mobile telephone number you provide to us.
CREDIT REPORT NOTICE: We may request a credit report for any legitimate purpose associated with your application for credit, extending credit, modifying the terms of your credit agreement, or collection on your account. On your request, we will inform you if such a report was ordered and will give you the name and address of the credit reporting agency t hat furnished the report.
ALABAMA AND NEBRASKA RESIDENTS: You must be 19 years old to apply for credit.
CALIFORNIA RESIDENTS: If married, you may apply for a separate account.
NEW YORK RESIDENTS: We may obtain your credit report and we will inform you, upon request, whether a report was obtained and, if so, the name and address of the consumer reporting agency.
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.
VERMONT RESIDENTS: WE may obtain your credit reports at any time, for any legitimate purpose associated with the account or the application or request for an account, including but not limited to reviewing, modifying, renewing and collecting on your account. On your request, we will inform you if such a report was ordered. If so, we will give you the name and address of the consumer reporting agency furnishing the report.
WISCONSIN NOTICE TO MARRIED APPLICANTS: No provision of any marital property agreement, unilateral statement under Wis. Stats. ss.766.59, or court decisions under Wis. Stats. ss766.70 adversely affects the interest of the creditor unless the creditor is furnished a copy of the decree, agreement, statement, or has actual knowledge of the adverse provision prior to the time credit is granted.

Applicant Name

Applicant Signature

Review your signature

Draw your signature

Date

Co-Applicant Name

Co-Applicant Signature

Review your signature

Draw your signature

Date

Dealer Rep Name

Dealer Rep Signature

Review your signature

Draw your signature

Date