CREDIT APPLICATION

Type applicant (Primary, Joint applicant or Guarantor)        Married      Single  
First Name       Initial       Last Name       Suffix  _____
Date of Birth       Social Sec #      Driver's Lic #       

Street Address  City  State   Zip
Mailing Address (if different) County
Years at Present Address  Prev. Address if less than 5 years
Home-  (Own, Buying or Rent)        Live with relatives       Rent or House Payment
Phone- Home   Work   Cell    e-mail

Current Employer Job Title   Years Employed
Employer Address  Phone
Gross Monthly Income (before taxes or deductions)   Other Income
Prev Employer if less than 5 years at present employer
Prev Employer Address   Phone

Nearest relative not living with you    Name     Relationship 
Address     Phone 

Type applicant (Co- applicant or Guarantor)?   
First Name       Initial       Last Name       Suffix____
Date of Birth  Social Sec #  Driver's Lic #  State
Current Employer   Job Title  Years Employed
Employer Address     Phone     
Gross Monthly Income (before taxes or deductions)  Other Income
Previous Employer if less than 5 years at present employer
Previous Employer Address  Phone

Financial Information-
Banks-    City   Checking   Savings   Both
                City   Checking   Savings   Both
Trade-In Loan Information- Lender  Loan Number    Payment
Home Mortgage Lender-     Balance 
Credit Accounts or Credit Cards-
Type-  (Credit Card or Open Account)  Credit Company      Balance
           (Credit Card or Open Account)  Credit Company      Balance
  Have you ever filed bankruptcy?     Have you ever had any property repossessed

References-
List 2 Personal Friends you have know more than one year with complete address and phone
Name  Address   Phone
            Address   Phone

Auto Insurance Company   Agent    Phone

NOTE: This application is for the purpose of securing credit.  I certify that the above information is true and complete to the best of my knowledge.  Applicants authorize Country Ford and its credit sources to check applicant's credit and employment history in order to secure financing for the vehicle intended to purchase.  I understand the most secure method to provide my private information is at the dealership in person or by fax.  I will, at the time of closing, sign an original credit application as a part of the finance documents.

Date-__________    Signatures X___________________          X_______________________