Auto Loan Application Form

Individual

Joint

Applicant please initial here:

Co-Applicant please initial here:

Amount Requested:

For How Long (Term in years):

Loan Purpose:

New or Used Vehicle Loan?

New

Used

Section A - Individual Applicant Information

First Name:

Middle Initial

Last Name:

Suffix

Social Security Number

Date of Birth:

Housing Arrangement: (please select one)

Own

Rent

Living Rent Free

Monthly Payment:

Physical Address: (number and street name)

City:

State:

Zip:

Phone Number:

How Long at Physical Address?

Years

Months:

Is your mailing address different than your physical address?

Yes

No

Mailing Address (PO Box or Number/ Street Name)

City:

State:

Zip:

ID Type

Driver's License

State ID

Passport

Military ID

Other

ID Number

Issuing Entity

Issue Date:

Expiration Date:

Email Address:

Current Employer:

Occupation:

How Long with Current Employer?

Years:

Months:

Gross Monthly Income:

Other Employment Income

Do you have Income from other employment?

Yes

No

Other Employer

Occupation

How Long with Employer?

Years:

Months:

Gross monthly Income

Previous Employer:

(if less than 6 months at current employment)

Occupation:

How Long with Previous Employer?

Years

Months:

Additional Income

Additional Income Disclosure: You need not list income from alimony, child support or separate maintenance if you do not want it considered in determining your ability to repay this obligation.

Is there any additional income you would like to include?

Yes

No

Additional Income Source:

(Social Security, VA, Pensions, Alimony, or Child Support)

Gross Monthly Income:

How Long?

Section B - Joint Applicant or Other Party Information

Complete only if for joint credit, for individual credit relying on income or assets from other sources, or applicant is married and resides in a community property state.

First Name:

Middle Initial

Last Name:

Social Security Number

Date of Birth:

Housing Arrangement: (please select one)

Own

Rent

Living Rent Free

Monthly Payment:

Physical Address:

(number and street name)

City:

State:

Zip:

Phone Number:

How Long at Physical Address?

Years

Months:

Issuing Identity

Issue Date:

Expiration Date:

Email Address:

Current Employer:

Occupation:

How Long with Current Employer?

Years

Months:

Gross Monthly Income:

Other Employment Income

Do you have income from other employment?

Yes

No

Other Employer

Occupation

How Long with Employer?

Years:

Months:

Gross Monthly Income

Previous Employer:

(if less than 2 years at current employment)

Occupation:

How Long with Previous Employer?

Years:

Months:

Additional Income

Additional Income Disclosure: You need not list income from alimony, child support or separate maintenance if you do not want it considered in determining your ability to repay this obligation.

Is there any additional income you would like to include?

Yes

No

Additional Income Source:

(Social Security, VA, Pensions, Alimony, or Child Support)

Gross Monthly Income:

Section C - Marital Status

Applicant:

Joint Applicant:

Collateral

Year

Make

Model

Section D - Declarations

Applicant

Are you a U.S. Citizen?

Yes

No

Co-Applicant

Are you a U.S. Citizen?

Yes

No

Signature

I certify that everything I have stated in this application is correct. You may keep this application whether or not it is approved. By signing below I authorize you to check on my credit and employment history and to answer questions others may ask you about my credit record with you. I understand that I must update credit information at your request if my financial condition changes. I also understand that I am executing this request for credit by electronic signature as defined by law, and I further understand that my electronic signature has the same force as a handwritten signature.

New York Residents Only: A consumer report may be requested in connection with this application or in connection with updates, renewals or extensions of any credit granted as a result of this application. Upon my request I will be informed whether or not a consumer credit report was requested, and if so, the name and address of the agency that furnished the report.

Ohio Residents Only: 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 request. The Ohio Civil Rights Commission administers compliance with this law.

If this is an application for joint credit, first applicant and joint applicant each agree that we intend to apply for joint credit by signing below.

First Applicant Signature

Date

Joint Applicant Signature

Please only click Submit button once. You will receive a Thank you screen once application has been successfully submitted.

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