Please fill in all fields that apply...
items in RED are required.
Personal Information
Last Name:
First Name:
Date Of Birth:
Social Security Number:
Driver License Number:
Home Phone (contact or message) Number:
This is my
home phone This is
a contact number
Present Street Address:
City:
Zip:
Time At Residence:
Time In Community:
Mortgage Co. / Landlord Name:
Landlord's Phone Number:
Do you rent or own?
Monthly Payment Amount:
Amount Of Child Support:
E-mail Address:
Best Time To Call:
Employment Information
Current Employer:
Street Address:
Employer City:
Employer State:
Employer Zip:
Occupation:
Estimated Salary:
Current Employer Phone:
Time On Job:
Work Shift:
Pay Period:
Day Of Week You Get Paid:
Do you have any other income to be considered? If so please explain.
Personal History
Check all that apply and explain in detail below.
I
have paid garnishments
I have declared
Chapter 7 Bankruptcy
I have declared
Chapter 13 Bankruptcy
I have had a
foreclosure
Explanations:
VEHICLE
If you are interested in a specific vehicle, please let us know the stock
number. If you are looking for something
specific, please let us know some
details of what you are looking for.
I hereby certify that the information in this application
is correct. I hereby authorize you or your agent to investigate the
data furnished by me. I understand that any false statements made on
this application will cause me to be in default under any contract between
us and subject to the remedies provided for by the contract. Adverse
action on this application will be noted on a copy of this application
given to me. I give American Auto, permission to contact my current
or previous employer. I give permission to American Auto, (or any
financial institution approved by American Auto) to access
my credit history (credit report) from any credit bureau.