Applicant Information
NAME (First. Middle, Last): Date of Birth: SSN: Number of Dependents (Excluding Yourself):
Street: City: State: Zip: Time at Address (Years and Months):
Previous Address: (If at Current Address Less Than 3 Years) City: State: Zip: Time at Previous Address (Years and Months):
Own Rent Live with Parents/Relatives Other If "Other" Explain: Mortgage or Rent payment:
Phone Number:
City: State: Zip:
Business Phone: Position: Monthly Income:
Time On Job (Years and Months): Other Income:
PREVIOUS EMPLOYER (If less Than 3 Years With Current):
City: State: Zip:
Business Phone: Position:
Time On Job (Years and Months):
Self Employed/Principal of Corp? (If you are self employed or own the business named above, enter years and months of ownership/self employment) Have You Ever Filed For Bankrupcy?
No Yes If Yes, Date?
Transaction Details
Year: Make: Model: Selling Price:  
Stock Number: Down Payment: Trade-In:Transaction Type: Transaction Term:
Trade-In Details (If Any. Enter Year, make, Model and Miles):
Authorization to Release Credit Information
Signer(s) hereby authorize Jay Hayfield Chevrolet - Buick and any of its agents, affiliates or designees (collectively "IFAI") to obtain business and/or personal financial information including without limitation, information from any credit bureau, consumer reporting agency, banking institution or other reporting source regarding Signer(s) and/or applicant(s) credit history, for purposes of evaluating this application. Signer(s) authorize and instruct any financial institution or entities possessing information about Signer(s) and/or applicant(s) to furnish IFAI with all such information.
I hereby affirm that the foregoing information is true and correct to the best of my knowledge. I understand that you will retain this application whether or not it is approved_ You are authorized to check my credit and employment history and to answer questions about your credit experience with me.
Please enter your full name to digitally sign this application