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Tuesday, March 09, 2010 ..:: Credit Application ::..   Login
 Tri-State Motors Credit Application Form Minimize
Fill out each section completely. All information given will be verified. Items left blank may significantly hurt your chances in obtaining credit.
Information Regarding Applicant
Name:
Address:
City:
State:
Zip:
How many years?:
Own or Rent:
Monthly Rent or Mortgage:
Home Phone:
Social Security No.:
Date of Birth:
Number of Dependents:
Previous Address #1
Previous Address (1):
City (1):
State (1):
Zip (1):
How long at prev. address? (1):
Previous Address #2
Previous Address (2):
City (2):
State (2):
Zip (2):
How long at prev. address? (2):
Landlord or Mortgage Holder:
Landlord/Mortgage Holder address:
Landlord/Mortage Holder Phone:
Banking Officer:
Employment Information
Employer or Company:
How long?:
If Self-Employed, Nature of Business:
Business Address:
Business City:
Business State:
Business Zip:
Business Phone:
Position:
Gross Monthly Income:
Net Monthly Income:
Source of Other Income:
Other Income Amount:
Net Total Monthly Income:
Previous Employer Information
Previous Employer:
Previous Employer Address:
Previous Employer Phone:
How long at prev. Employer?:
Savings Information
Savings Bank Name:
Savings Bank Branch:
Savings Bank Phone:
Savings Account No.:
Savings Balance:
Checking Information
Checking Bank Name:
Checking Bank Branch:
Checking Bank Phone:
Checking Account No.:
Checking Balance:
List 2 Nearest Relatives and One Personal Friend
Nearest Relative #1 (not living with you):
Relative #1 Phone:
Relative #1 Relationship:
Relative #1 Address, City, State, Zip:
Nearest Relative #2 (not living with you):
Relative #2 Phone:
Relative #2 Relationship:
Relative #2 Address, City, State, Zip:
Personal Friend Name, Address, Phone Number:
Have you ever filed bankruptcy?:
If yes, Date:
Have you ever had a repossession?:
If yes, what was repossessed?:
If yes, when did the repossession happen?:

By submitting this form, you are indicating that you agree with the terms of this credit application as described below. All the information given on this application is true, correct and complete. We or our assignee is authorized to exchange credit information covering this application and any credit granted. As part of the credit investigation process, we or our assignee may request a consumer report or commercial credit report in connection with this application for credit or any update, renewal or extension thereof. Upon request, we or our assignee will tell you whether or not a consumer report or commercial credit report was obtained and the name and address of the consumer reporting agency. I agree that we or our assignee may retain this application whether or not credit is approved. For purposes of securing credit and preparing documents, the signers agree and warrant that the above statements are true and correct. Automobile insurance is required for the full term of the Contract, at my expense against the hazards of fire, theft, and accidental physical damage (including collision). This insurance must protect our interests. The policies issued by the insurance company will describe the terms and conditions. I MUST CHOOSE THE COMPANY THROUGH WHOM INSURANCE IS OBTAINED. FAIR CREDIT REPORTING ACT DISCLOSURE This application for credit will be submitted to Lease and Rental Management Corp. dba Auto Loan, or dba Auto Use, (whichever is applicable), Andover, MA for purchase or consideration as to whether it meets credit requirements. I certify that the above information is complete and accurate. I authorize an investigation of my credit and employment history and the release of information about my credit experience.
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