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:
Email:
Phone Number:
CURRENT EMPLOYER:
Street:
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):
Street:
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?
CO APPLICANT
CO APPLICANT NAME (First, Middle, last): Date of Birth: SSN: Phone Number:
Street: City: State: Zip:
Time at Address (Years and Months: Email:
EMPLOYER:
Address:
City: State: Zip:
Business Phone: Position: Monthly Income:
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 and co-applicant's full name to digitally sign this application