Credit Application

Note: Please provide as much information as possible. *Required Field
1. First Name:*
 MI:
 Last Name:*
2. Social Security Number:* - -
3. Date of Birth:* / / (mm) /  (dd) /  (yyyy)
4.

Contact numbers where you can be reached:*
1 - ( )- -    Contact Type: Other    Home Phone    Cell/Mobile    Pager    Work
1 - ( )- -    Contact Type: Other    Home Phone    Cell/Mobile    Pager    Work

What is the best time to contact you?*

5. E-mail Address:
6. Current Mailing Address:*
  Street:
   
  City:    State:    Zip:
7. Number of Years / Months At Current Residence:
    Own Rent    Monthly Payment:
8. Previous Address: (If less than 2 years at current address)
  Street:
   
  City:    State:    Zip:
9. Current Employer (if retired, last employer)
  Street:
   
  City:    State:    Zip:
10. Telephone Number:  1 - ( )- -
11. Position / Title: 
12. Years Employed:
13. Gross Monthly Income:
14. Previous Employer (If less than 2 years at current employer)
  Street:
   
  City:    State:    Zip:
15. Other Income:$
16 Do you have access to a Co-Applicant?:  Yes     No

Additional Information
17. Has any of your property ever been repossesed?  Yes     No
      if yes, when?
18. Have  you  been  personally  involved  in  a  bankruptcy  proceeding  last  ten  years?
Yes     No
19. Are  you  an  endorser  or  guarantor  on  any other  loan  or  contract?
Yes     No
20. Are  there  unsatisfied  judgements (suits  pending)  against  you?
Yes     No
21.

Your Previous Vehicle:

Last  vehicle  financed  through  what  financial institution?

Balance  due  or  unpaid:  $
Are you trading in this car?  Yes     No
Insurance Company: 

22. List of Bank references & other information:
23. How much cash down can you provide? $
24. What type of vechicle are you interested in?
25. Do you have a trade?  Yes     No
 

Estimated Payoff:

  Trade Description:
  Year: Make: Model: Miles: Additional Info:
 
27. Any Additional Information or comments that would be helpful in processing your application:
Final Info and Submit Application
1. Authorization  to  check  credit?* Yes

Have Comments or Questions
about this application?
Contact AJ Kightlinger
1-800-477-5277 ext 31
aj@kightlinger.com
2. Type your Full Name:*

3.

 Enter Today's Date:* / / (mm) /  (dd) /  (yyyy)

 

 

 

 

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