J. GREEN AUTO WHEELS Credit Application

 

Primary Applicant

 
* First Name
Middle Name
* Last Name
* Date of Birth
Applicants must be at least 18 years of age
* Social Security Number
* Contact Phone
* Email
 

Residence

* Address
* City
* State
* Zip Code
* Residence
* Time at residence
       
* Monthly Pmt/Rent
$
If you do not pay rent or a mortgage, enter a zero.
 

Previous Residence

* Previous Address
* Previous City
* Previous State
* Previous Zip Code
* Time at residence:
       

Driver License

*  License Number
*  License State
*  License Expiration
 
 

Current Employment

Employment
* Employer's Name
* Employer's Phone Number

Ex: 111-222-3333. If unemployed, use your contact number.
* Occupation
* Time on Job
         
* Monthly Income
$ 
Gross Pay, Before Taxes (numbers only)
 

Previous Employment

Employment
* Employer's Name
* Employer's Phone Number

Ex: 111-222-3333. If unemployed, use your contact number.
* Occupation
* Time on Job
         

Other Income

Other Monthly Income
$ 
Before Taxes (numbers only)
Income Source
 
 

* Relationship to Applicant
* First Name
Middle Name
* Last Name
*  Date of Birth
Applicants must be at least 18 years of age
*  Social Security Number
*  Contact Phone
E-mail
 
 
 

Residence

*  Address
*  City
*  State
*  Zip Code
* Residence
*  Time at Residence
       
*  Rent/Mortgage
$ 
If you do not pay rent or a mortgage, enter a zero.
 

Previous Residence

*  Address
*  City
*  State
*  Zip Code
*  Time at Residence
     
 

Driver License

*  License Number
*  License State
*  License Expiration
 

Current Employment

 
*  Employer's Name
*  Employer's Phone Number
*  Occupation
*  Time on Job
         
*  Monthly Income
$ 
Gross Pay, Before Taxes (numbers only)
 

Previous Employment

 
*  Employer's Name
*  Employer's Phone Number
*  Occupation
*  Time on Job
         
 

Vehicle Of Interest
Model Year
Make
Model
Mileage
Numbers only, please. If you're not sure, leave this field blank.
VIN
If you're not sure, leave this field blank.
Price
$
Numbers only, please. If you're not sure, leave this field blank.
Cash Down
Use this field for cash down only.
Enter trade equity / payoff / allowance below.
If you're not sure, enter a zero.
 
Do you wish to include title, plate, and registration fees in the amount financed?
 

Trade In
Numbers only, please. If you're not sure, leave this field blank.
If you're not sure, leave this field blank.

 

Important Info: Please Read!

I authorize Dealer ("you" and "your") and any finance company, bank, or other financial institution to which the Dealer submits my application to investigate my credit and employment history, obtain credit reports, and release information about your credit experience with me as the law permits.

If an account is created, I authorize you to obtain credit reports for the purpose of reviewing or taking collection action on the account, or for other legitimate purposes associated with the account.

* I certify that I have read and agree to the terms of this application and that the information in it is complete and true.

 
 

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