Auto Loan Application Form

Auto Loan Application Form

Date of Application:    Application ID (if assigned):

Applicant Information

Date of Birth:    Driver's License #:    State Issued:

Years at Address:    Residence Type: Own Rent Other

Employment & Income

Job Title:    Years Employed:    Work Phone:

Vehicle & Purchase Information

Vehicle Status: New Used

Year:    VIN:    Mileage:

Loan Request

Desired Term (months):    Payment Frequency: Monthly Bi-weekly Weekly

Trade-in & Liens

Is there a trade-in vehicle? Yes No

References

Authorizations, Certifications & Notices

By signing below, Applicant authorizes the lender and its agents to obtain consumer and commercial credit reports and other consumer reports, and to verify employment, income and other information provided in this application from any source. Applicant certifies that all information provided in this application is true, complete and correct and understands that intentionally false statements may be a violation of law and a basis for denial or rescission of credit.

Applicant acknowledges that this application is an inquiry for credit and is not a promise to lend or an agreement to extend credit. Any offer of credit will be governed by a separate written loan agreement executed by Applicant and the lender. Applicant consents to electronic transmission of disclosures, documents and notices where permitted by law.

Applicant further authorizes the lender to share information with service providers, affiliates and assignees for the purposes of processing, servicing or collecting on the loan. Applicant has read and understands the foregoing authorizations and hereby grants permission to obtain such information.

Acknowledgement

Applicant certifies under penalty of perjury that the information contained in this application is true and correct to the best of Applicant's knowledge. Applicant understands that misrepresentations or omissions may be grounds for immediate denial of credit or termination of any credit extended, and may be a criminal offense.

Applicant acknowledges receipt of any required initial disclosures at or prior to application where applicable and understands that additional disclosures will be provided upon conditional approval or before consummation of any loan.

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