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FINANCE APPLICATION

FINANCE APPLICATION. This IS NOT an online application. You may fill in the form online but Please PRINT the application and fax it to us at 603-642-7701

 


Auto Loan Request

Amount Requested:
Type of Application: Individual Applicant Joint Applicant
Term Requested:
24 mos. 36 mos. 48 mos. 60 mos. Other
Year of Vehicle
 Make
 Model
Purchase Price
 Down Payment
 Finance Amount
Dealer Name:   AUTOTOWN INC.
Trade-In Yes No Creditor of Trade-In


Applicant

First Name
 Middle Initial
 Last Name
Date of Birth
 Social Security No.
 No. of Dependents
Driver's License No.
 Driver's License State
 Your E-mail Address
Home Phone
 Best Time To Call
 Work Phone


Residence

Your Primary Residence:
Own with Mortgage Own Clear Rent Other
Present Street Address
 City
 State
 Zip
Years At Present Address
 Your Monthly Rent or Mortgage Payment
Years At Previous Address
 Your Previous Address


Employment

Employed Self-Employed Retired Unemployed Student
Your Present Employer
 Phone
City
 State
 Zip
Gross Monthly Salary
 Your Positon
 Years There
You do not have to list alimony, child support or separate maintenance income unless you want us to consider it for the purposes of granting and repayment of this credit request.
Other Monthly Income
 Source of Other Income
Previous Employer
(if less than 3 years at current employer)
 Years at
Previous Employer


Additional Information

Name of Your Bank/CU
  


Co-Applicant

First Name
 Middle Initial
 Last Name
Date of Birth
 Social Security No.
 No. of Dependents
Driver's License No.
 Driver's License State
 Your E-mail Address
Home Phone
 Best Time To Call
 Work Phone


Co-Applicant Residence

Your Primary Residence:
Own with Mortgage Own Clear Rent Other
Same as above
Present Street Address
 City
 State
 Zip
Years At Present Address
 Your Monthly Rent or Mortgage Payment
Years At Previous Address
 Your Previous Address


Co-Applicant Employment

Employed Self-Employed Retired Unemployed Student
Your Present Employer
 Phone
Street Address
 City
 State
 Zip
Gross Monthly Salary
 Your Positon
 Years There
You do not have to list alimony, child support or separate maintenance income unless you want us to consider it for the purposes of granting and repayment of this credit request.
Other Monthly Income
 Source of Other Income
Previous Employer
(if less than 3 years at current employer)
 Years at
Previous Employer
Street Address
 City
 State
 Zip


Co-Applicant Additional Information

Name of Your Bank/CU
  


Applicant(s) Statement
I/We have completed this request for credit in consideration of a loan to me and/or others upon my guarantee. I/We certify that all information contained herein is accurate and complete to the best of my knowledge.

I/We authorize you to retain property of this application, to rely on the foregoing, to check and verify my credit, employment and salary history, to secure follow up credit reports concerning my credit worthiness and to exchange information about my account with proper persons, creditors and credit bureaus.

I authorize my employer (present and future), bank and other references listed above to release and/or verify information at any time. I acknowledge that this application is subject to approval of credit and acceptance. Should my request for credit and subsequent loan be approved, I agree to give written notice immediately upon change of my name, address, employment or any other pertinent information contained herein.

      SIGNATURE APPLICANT ______________________________ DATE _______

SIGNATURE CO-APPLICANT _____________________________ DATE _______