Credit Application

  • Please fill in the application completely.

    Personal Information

    Last Name First Name MI
    Present Address County
    City State Zip
    How Long at address?
    Previous Address (if less than two years at current) County
    City State Zip
    How Long at address?
    Social Sec. Number Date of Birth Home Phone
    Email Address Cell Phone
    Present Employer Work Phone
    Employer's Address Date Employed
    Income Per Occupation
    Other Income Per Source of Other Income
    Previous Employer Occupation How Long?
     

    Credit Information
    Name of Creditor (Home Mortgage or Landlord) Present Balance Monthly Payment
    Auto Loan Creditor Present Balance Monthly Payment
     

    References
    Name of relative not living with you Relationship
    Address Phone Number
    Are any of your debts past due? Yes No
    Have you ever had your furniture, auto, or property repossessed? Yes No
    Have you ever declared bankruptcy? Yes No
    Are you currently a co-signer on a loan? Yes No
     
    Will you have a cash down-payment for the vehicle you want to buy? Yes No
    How much will you put down?
    Please describe your trade-in (year, make, model, trim, miles, and condition):
     

    Applicant's "Signature"

    All the information in this application is true. I understand that section 1014 Title 18 U.S. Code makes it a federal crime to knowlingly make a false statement on this application. You have my permission to check it. You may retain this application even if not approved. I understand that you may receive information from others about my credit and you may answer questions and requests from others seeking credit or experience information about me or my accounts with you. If this application is approved, I agree to honor the provisions of the agreements covering my loan or account.

    The Ohio laws against descrimination 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.
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