CREDIT INFORMATION

Type applicant (Primary, Joint applicant or Guarantor)?   Choose One Primary Joint Applicant Gaurantor      Married      Single  
First Name       Initial       Last Name       Suffix  None Jr. Sr.
Date of Birth       Social Sec #       Driver's Lic #       State 

Street Address       City      State       Zip 
Mailing Address (if different)       County 
Years at Present Address       Prev. Address if less than 5 years 
Home   Choose One Own Home Outright Buying Home Living With Relatives Leasing/Renting Other      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 
Previous Employer if less than 5 years at present employer  
Previous Employer Address       Phone 

Nearest relative not living with you    Name     Relationship 
                Address     Phone 
 

CO-APPLICANT (If any)

Type applicant (Primary, Joint applicant or Guarantor)?   Choose One Primary Joint Applicant Gaurantor
First Name       Initial       Last Name       Suffix  None Jr. Sr.
Date of Birth       Social Sec #       Driver's Lic #       State 

(Complete only blanks different from Applicant)
Street Address      City      St      Zip 
Mailing Address (if different)       County 
Years at Present Address       Prev. Address if less than 5 years 
Home   Choose One Own Home Outright Buying Home Living With Relatives Leasing/Renting Other      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 
Previous Employer if less than 5 years at present employer   
Previous Employer Address       Phone 

Nearest relative not living with you    Name     Relationship 
                Address     Phone 
 

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

 
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 
 

Security Question Choose One Mother's Maiden Name Favorite Pet Where you were born     Type Answer

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.