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Are you

Buying Renting Other

Are you on the lease or mortgage?

No Lease Mortgage

If leasing is it?

Month-to-month Long term

This is a

House Apt Mobile Home

Is the payment current?

Yes No

Mailing Address

(if different from above)

Are you paid hourly or salary?

Hourly Salary

How often are you paid?

Weekly Bi-weekly Semi-monthly Monthly

Do you have a part-time job?

Yes No

* (Spousal income, 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.)

Are you in the military?

Yes No

Are you?

Active Inactive

The vehicle I am purchasing is for

Personal Use Business Use

The vehicle I am purchasing is for

Myself Someone else

Primary Applicant Personal References

Proof of Residence

Proof of Income

Please Check

Yes I, the Applicant, certify that all of the statements in this application are true and complete and are made for the purpose of obtaining credit.

Questions / Comments?

Do you Have a Co-Applicant? (co-buyer, co-signer)

Yes No

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Applicant

Current Address

Mailing Address

Residence Continued

Employment

Other Income

Other

Primary Applicant Personal References

Questions / Comments?

POLICY