World Of Wheels Autoplex, Inc.

APPLICANT INFORMATION

E-Mail Address

First / Middle / Last Name	/ / /
Address
City / State / Zip	/

County	Home Phone		Housing
	(e.g. 555-555-5555)
Landlord or Mortgage Holder Rent or Mortgage Payment			Time at Address
	(e.g. $0,000)		Years Months

Previous Address (if less than two (2) years at current address)
Address
City / State / Zip	/

Date of Birth	Social Security Number		Drivers Lic. / State
(e.g. mm/dd/yyyy)	(e.g. 555-55-5555)		/

EMPLOYMENT INFORMATION

Current Employer
Address
City / State / Zip	/
Employer Phone	(e.g. 555-555-5555)

Occupation (if Military, Rank)	Gross Monthly Salary		Time with Current Employer
	(e.g. $000,000)		Years Months

Other Income - Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Source of Other Income	Other Income (annual)
	(e.g. $000,000)

Previous Employer
Address
City / State / Zip	/
Employer Phone	(e.g. 555-555-5555)

Occupation (if Military, Rank)	Gross Monthly Salary		Time with Previous Employer
	(e.g. $000,000)		Years Months

FINANCIAL INFORMATION

Name of Bank	Account Type (check all that apply)
		No Account		Checking Only
		Checking & Savings		Savings Only

Have you ever had a car or other merchandise re-possesed?
If Yes, when?			(e.g. mm/dd/yyyy)
Have you ever filed bankruptcy?
If Yes, when?			(e.g. mm/dd/yyyy)

	(1) Creditor's Name
	City / State		/
	Date Opened		(e.g. mm/dd/yyyy)
	Monthly Payment Amount		(e.g. $000,000)
	Unpaid Balance		(e.g. $000,000)

	(2) Creditor's Name
	City / State		/
	Date Opened		(e.g. mm/dd/yyyy)
	Monthly Payment Amount		(e.g. $000,000)
	Unpaid Balance		(e.g. $000,000)

	(3) Creditor's Name
	City / State		/
	Date Opened		(e.g. mm/dd/yyyy)
	Monthly Payment Amount		(e.g. $000,000)
	Unpaid Balance		(e.g. $000,000)

	(4) Creditor's Name
	City / State		/
	Date Opened		(e.g. mm/dd/yyyy)
	Monthly Payment Amount		(e.g. $000,000)
	Unpaid Balance		(e.g. $000,000)

NEAREST RELATIVES / FRIENDS NOT IN HOUSEHOLD

	(1) First / Last Name		/
	Address
	City / State / Zip		/
	Phone		(e.g. 555-555-5555)
	Relationship

	(2) First / Last Name		/
	Address
	City / State / Zip		/
	Phone		(e.g. 555-555-5555)
	Relationship

	(3) First / Last Name		/
	Address
	City / State / Zip		/
	Phone		(e.g. 555-555-5555)
	Relationship

	(4) First / Last Name		/
	Address
	City / State / Zip		/
	Phone		(e.g. 555-555-5555)
	Relationship

CO-APPLICANT

E-Mail Address:

First / Middle / Last Name	/ / /
Address
City / State / Zip	/

County	Home Phone		Housing
	(e.g. 555-555-5555)
Landlord or Mortgage Holder Rent or Mortgage Payment			Time at Address
	(e.g. $0,000)		Years Months

Previous Address (if less than two (2) years at current address)
Address
City / State / Zip	/

Date of Birth	Social Security Number		Drivers Lic. / State
(e.g. mm/dd/yyyy)	(e.g. 555-55-5555)		/

MISCELLANEOUS

For the purpose of securing credit from you, I certify that the above information is true and complete to the best of my knowledge. Applicant further certifies that I have attained the age of majority. Applicant authorizes you, to check my credit and employment history and to provide and/or obtain information about credit experience with me.

Your Opt-Out Right: If you do not want to share non-public personal information about you related to this application with affiliates and non-affiliated thrid parties of this dealership, other than what is permitted by law, you may opt-out of Information Sharing via this drop-down menu. See the Financial Privacy Policy for more information.

AUTHORIZATION

By typing your name, you certify that all of the information above is true and you authorize us to use the information to process your request to obtain credit on your behalf.
	(e.g. First / Last Name)		(e.g. mm/dd/yyyy)