dba Excel Auto Lounge
Loan Amount:
Monthly Payment:
Down Payment:
First Name:
Middle Name/Initial:
Last Name:
Your Full Address:
Daytime Phone:
Evening Phone:
Fax:
Email:
Social Security Number:
Date Of Birth:
Time at Residence:
Mortgage / Rent Payment:
Residence Type: —Please choose an option—Own Home With MortgageOwn Home Without MortgageRentLive With RelativeOther
If you have lived at your current residence less than 5 years, please enter your prior address:
Which accounts are in your name: UtilitiesSavingsCheckingPhone
Drivers Lic#:
Drivers Lic. State:
Drivers Lic. Exp. Date:
Employer Name:
Employer Address:
Business Phone:
Occupation:
Employment Status: —Please choose an option—Full TimePart TimeRetiredMilitarySelf-EmployedContractSeasonalTemporaryUnemployed
Time on Job:
How often are you paid: —Please choose an option—WeeklyBi-WeeklyMonthlyYearlySemi-Monthly
How much per paycheck:
Other income: (if any)
Consent: I agree that by submitting this application, I authorize and give this dealership, as well as any potential financing source this dealership presents this application to, my consent to obtain my credit report from any credit reporting agency used to complete an investigation of my credit.
Make:
Model:
Vehicle Year:
Vehicle Mileage:
Trade-in Make:
Trade-in Model:
Trade-in Year:
Trade-in Mileage:
Additional Comments:
Co-Borrower Info (if any):
By submitting this application, I certify that all information herein is true and complete. I agree I am providing this information to the dealer identified in this application and acknowledge that my information may be shared pursuant to the dealer’s privacy policy, if applicable. I hereby authorize this dealer, and any financial institution engaged as a service provider by this dealer, to retain this application and to check and verify my credit, employment and salary history. By submitting this application, I acknowledge I am authorizing this dealer to check my credit.
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