Application – car dealer

Customer Credit Application

Read to applicant: “If married, you have the right to apply for credit separately from or jointly with your spouse.”

Individual Credit Joint Credit

Loan information

Purpose Amount requested ($) Source / dealer

Applicant

Last name ^* First name ^* Middle name

Social Security No. ^* Date of birth ^* No. dependents

Residence address (Street, City, State, Zip) ^* How long (yrs) How long (mos)

Mailing address (if different) Home phone Cell phone ^*

Previous address (if less than 2 yrs) How long (yrs) How long (mos)

Email ^* Housing status ^* Landlord / mortgage holder Rent / mortgage / mo ($)

Applicant — employment & income

Employer's name and address ^* Occupation ^*

How long (yrs) How long (mos) Work phone Ext.

Monthly income — gross ($) ^* Monthly income — net ($) Other monthly income — gross ($)

Previous employer How long (yrs / mos)

Source(s) of other income Total monthly income — gross ($) Total monthly income — net ($)

Income from alimony, child support, or separate maintenance need not be revealed if you do not choose to rely on such income in applying for credit.

Are you obligated to pay alimony, child support, etc.? If yes, amount ($)

Auto yr / model #1 Financed by #1 Auto yr / model #2 Financed by #2

Authorization & signatures

I/We the undersigned Applicant(s) for credit do hereby affirm that the information contained in this application is true and correct in all respects and I/we understand that it will be relied upon by Select Used Auto Sales and any seller of goods or assignee in making the decision to extend credit to me/us. I/we authorize Select Used Auto Sales and any assignee to make whatever inquiries they deem necessary to verify the information contained in this application, including obtaining my/our personal credit reports.

I/We consent to being contacted by phone, text message, or email at the contact info provided above. This consent includes making calls using an automatic telephone dialing system or an artificial or prerecorded voice message.

Ohio Disclosure: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy 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.
California Disclosure: Married persons may apply for separate accounts.

Driver's license no. & state (or State I.D. No.) ^* Applicant's signature (typed name) ^* Date ^*

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