Credit Application
*Required Field
Note: Please provide as much information as possible
1.
* First Name: MI: * Last Name:
2. * Social Security Number: - - (555-55-5555)
3. * Date of Birth: / / (01/02/09)
4. Contact numbers where you can be reached:
  *( ) - Contact Type: Home Phone Cell/Mobile Work Pager Other
  ( ) - Contact Type: Home Phone Cell/Mobile Work Pager Other
  * What is the best time to contact you?
5. * Email:
6. Current Mailing Address:
  *Street:
 
  *City:
  *State: *Zip:
  *Country:
7. *Number of Years / Months At Current Residence:
  Own Rent    Monthly Payment: $
8. Previous Address: (If less than 2 years at current address)
  Street:
 
  City:
  State: Zip:
9. *Current Employer (if retired, last employer):
 
  * Street:
 
  * City:
  * State: * Zip:
10. * Phone: ()-
11. *Position / Title:
12. *Years Employed:
13. *Gross Monthly Income: $
14. Previous Employer (If less than 2 years at current employer):
 
  Street:
 
  City:
  State: Zip:
15. Other Income: $
16. Do you have access to a Co-Applicant? Yes No

Additional Information
17. Has any of your property ever been repossesed? Yes No
  if yes, when?
18. Have you been personally involved in a bankruptcy proceeding last ten years?
  Yes No
19. Are you an endorser or guarantor on any other loan or contract?
  Yes No
20. Are there unsatisfied judgements (suits pending) against you?
  Yes No
21. Your Previous Vehicle:
  Last vehicle financed through what financial institution?
 
  Balance due or unpaid: $
  Are you trading in this car? Yes No
  Insurance Company:
22. List of bank references & other information:
 
23. *How much cash down can you provide?
24. *What type of vechicle are you interested in?
25. *Do you have a trade? Yes No
  Estimated Payoff: / / (01/02/09)
  Trade Description
 
Year: Make: Model: Miles: Additional Info:
26. Any Additional Information or comments that would be helpful in processing your application:
 

Final Information & Submit Application
27. *Authorization to check credit?: Yes No Have Comments or Questions
about this application?
Contact AJ Kightlinger
1-800-477-5277 ext 31
save@kightlinger.com
28. *Type your Full Name:
29. * Enter Today's Date: / / (01/02/09)
30. * Security Code: