Auto Save Group | Credit Application

Name*

First Last

Date of Birth*

Number of Dependents*

Social Security Number*

Phone Number*

Address*

Street Address Address Line 2 City State ZIP Code

Years at Current Address*

Email Address*

Residential Status*

Monthly Rent/Payment*

Landlord or Mortgage Holder Name*

Previous Address*

Same as previous

Street Address Address Line 2 City State ZIP Code

Current Employers Name*

Current Employer Address*

Street Address Address Line 2 City State ZIP Code

Gross Monthly Salary*

Work Phone Number*

Job Occupation*

Length at Employment*

Drivers License Number*

Other Income

Note-Alimony, child support, or separate maintenance incomes do not have to be revealed unless the applicant wishes to have such sources considered as a basis for repayment of the requested credit amount.

Gross Monthly Income*

Other Sources of Income*

Applicant References

Please list the following references for personal creditability reasons.

Reference #1

First Last

Relationship

Phone Number

Address

Street Address Address Line 2 City State ZIP Code

Reference #2

First Last

Relationship

Phone Number

Address

Street Address Address Line 2 City State ZIP Code

Co-Joint Applicant

Person or persons applying for credit as a joint collaboration

Name

First Last

Date of Birth

Social Security Number

Number of Dependents

Address

Street Address Address Line 2 City State ZIP Code

Years at Address

Phone Number

Residential Status

Monthly Rent/Payment

Previous Address

Same as previous

Street Address Address Line 2 City State ZIP Code

Current Employer

Current Employer Address

Street Address Address Line 2 City State ZIP Code

Authorization*

CHECKING THE AGREE BOX BELOW MEANS YOU CERTIFY THAT ALL INFORMATION GIVEN BY YOU ON THIS APPLICATION IS COMPLETE AND ACCURATE. YOU GIVE PERMISSION FOR ANY FINANCIAL INSTITUTE WHICH WILL REVIEW THIS CREDIT APPLICATION TO INVESTIGATE YOUR CREDIT AND EMPLOYMENT HISTORY AND TO ANSWER QUESTIONS ABOUT THEIR EXPERIENCE WITH YOU INCLUDING BUT NOT LIMITED TO LATE PAYMENTS, MISSED PAYMENTS OR ANY OTHER DEFAULTS, AND THIS INFORMATION MAY BE REPORTED IN YOUR CREDIT REPORT.

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Credit Application

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Other Income

Applicant References

Co-Joint Applicant

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