Customer - Apply Now PRINT FULL NAME*DOBSSN# OF DEPENDENTSAddress STREET ADDRESS CITY STATEAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific STATE ZIPCODE HOW LONG IN YEARS/MONTHS - RESIDENCE?HOME PHONE*CELL PHONERESIDENTIAL STATUSRESIDENTIAL STATUSRentOwnFamilyOtherMONTHLY RENT/MORTGAGE PMTLANDLORD OR MORTGAGE HOLDER’S NAMEPREVIOUS ADDRESS (if less than 2 yrs at current address)CURRENT EMPLOYER’S NAME*CURRENT EMPLOYER’S ADDRESSGROSS MONTHLY SALARY*Please input accurate gross monthly income (before taxes withheld). This income will be verified prior to completion of loan.WORK PHONEOCCUPATION/JOB TITLE*HOW LONG YEARS/MONTHS - EMPLOYED?PREVIOUS EMPLOYER (if less than 2 yrs on current job)HOW LONG?GROSS MONTHLY OTHER INCOMEOTHER INCOME SOURCEDO YOU HAVE A SPECIFIC VEHICLE TO PURCHASE? WHAT IS IT?Enter specific vehicle or type (Yr, Make, Model, Miles OR Car/Truck/SUV/Motorcycle)DO YOU CURRENTLY OWN THIS VEHICLE?Are you borrowing money to purchase a vehicle or against a vehicle you own fee and clear?MAX MONTHLY PAYMENT*This does not guarantee you for approval for specified amount but gives us an idea of what you are looking for.INITIALS*By initialing box you agree to terms Δ "Application Disclosure and Agreement The words "you", "your" and y"ours" mean each person submitting this application and any non-Applicant spouse whose information is provided if the Applicant resides in a community property state or the vehicle may be located in a community property state. The words "we", "us", "our" and "ours" as used below refer to us, our partner dealers, or to other financial institutions selected to receive your application to which we may assign your contract and whose names and addresses we may disclosed to you. You authorize us to submit this application and any other application submitted in connection with the proposed transaction to the above-referenced dealers financial institutions. This application will be reviewed by such financial institutions on behalf of themselves and us the dealer. In addition, as permitted under the Fair Credit Reporting Act, you authorize such financial institutions to disclose information about you or submit your applications to other financial institutions for the purpose of evaluating your request for credit. You agree that we may obtain a consumer credit report periodically from one or more consumer reporting agencies (credit bureaus) in connection with the proposed transaction and any update, renewal, refinancing, modification or extension of that transaction. You also agree that we or any affiliate of ours may obtain one or more consumer credit reports on you at any time whatsoever. If you ask, you will be told whether a credit report was requested, and if so, the name and address of any credit bureau from which we or our affiliate obtained your credit report. You agree that we may verify your employment, pay, assets and debts, and that anyone receiving a copy of this is authorized to provide us with such information. You further authorize us to gather whatever credit and employment history we consider necessary and appropriate in evaluating this application and any other applications submitted in connection with the proposed transaction. Other Income disclosure: “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”. We may keep this application and any other application submitted to us, and information about you whether or not the application is approved. You certify that all of the information on this application and in any other application submitted to us, is true and complete. You understand that false statements may subject you to criminal penalties. You also understand that each dealer and financial institution will rely on the information on this application in making its decision on your application. FEDERAL NOTICES IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. STATE NOTICES California Residents: An applicant, if married, may apply for a separate account. Balloon contract is an installment sale contract with a scheduled final payment that is at least twice the amount of the one of the earlier scheduled equal periodic installment payments. New York Residents: In connection with your application for credit, we may request a consumer report from a consumer reporting agency (credit bureau), which contains information on your credit worthiness, credit standing, personal characteristics and general reputation. If we grant you credit, we or the person(s) extending credit or holding such credit account may order additional consumer reports in connection with any update, renewal or extension of the credit. If you ask, you will be told whether we requested a consumer report and if we did, we will tell you the name and address of the consumer reporting agency that gave us the report. Ohio Residents: Ohio laws against discrimination require that all creditors make credit equality 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. Vermont Residents: You authorize dealer and any financial institution with which this credit application is shared, and each of their respective employees or agents to obtain and verify information about you (including one or more credit reports, information about your employment and banking and credit relationships) that we or they may deem necessary or appropriate in evaluating your credit application. If your application is approved and the credit is granted, you also authorize the parties granting credit and/or holding your account and their respective employees and agents, to obtain additional credit reports and other information about you in connection with reviewing the account, increasing the available credit on the account (if applicable), taking collection on the account, or for any other legitimate purpose. Married Wisconsin Residents: Wisconsin law provides that no provision of any marital property agreement, or unilateral statement, or court order applied to marital property will adversely affect a creditor's interests unless, prior to the time that the credit is granted, the creditor is furnished with a copy of the agreement, statement or decree, or has actual knowledge of the adverse provision. If you are making this application individually, and not jointly with your spouse, the full name and current address of your spouse must be properly disclosed in the co-applicant section of this application."