Secure Online Credit Application
*
######Denotes * Field
VEHICLE OF INTEREST
Year:
Make:
Model:
Stock #:
PURCHASE INFORMATION
Down Payment:
PRIMARY APPLICANT PERSONAL INFORMATION
Social Security #:
*
Social Security information is used for approval and funding of an auto loan. This information will not be shared for any other purpose.
Drivers License:
*
Date of Birth:
*
Email Address:
Full Name:
*
Home Address ( # / street / apt ):
*
City / State / Zipcode:
N/A
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
*
Rent or Own:
Rent
Own
Own Clear
Rent or Mortgage Amount:
Residency Length:
Year
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
25+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Home Telephone:
*
Mobile Telephone:
Only Fill Out Previous Address if you have been at your current address 3 years or less
Previous Home Address ( # / street / apt ):
Previous City / State / Zipcode:
N/A
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
EMPLOYMENT INFORMATION
Employer:
*
Self Employment:
No
Yes
Job Title:
*
Work Telephone:
*
Employment Length:
Years
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
25+
Months
0
1
2
3
4
5
6
7
8
9
10
11
12
Approx. Gross Income (Monthly before taxes):
NOTE: Based on the length of time on your current JOB, you
MUST
Fill out the Previous Employer Information
PREVIOUS EMPLOYMENT INFORMATION
Previous Employer:
Previous Self Employment:
No
Yes
Previous Job Title:
Previous Work Telephone:
Previous Employment Length:
Years
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
25+
Months
0
1
2
3
4
5
6
7
8
9
10
11
Approx. Gross Income (Monthly before taxes):
In submitting this credit application, I/We certify that the information provided on this application is, to the best of my/our knowledge, complete and accurate. I/We understand that the Dealer and financial institution(s) will rely on this information to judge my/our credit worthiness, and will retain this application and information about me/us whether or not this application is approved. Further, I/We authorize an investigation of my/our credit and employment history, in conjunction with which my/our credit report(s) may be obtained from one or more consumer credit reporting agencies. I/We understand that false statements may subject me/us to criminal penalties. I/We further understand that the Dealer and/or the financial institution(s) that evaluate my/our application may require additional information. FAIR CREDIT REPORTING ACT DISCLOSURE: I/We understand that this application for credit will be submitted by the dealer to various financial institutions for evaluation. Before this application is submitted, the Dealer will disclose to me the name and addresses of each institution that will receive copies of this application.
By checking the box, I agree to the terms and conditions of this application and give
permission to the Bendi's Auto Sales & Repair Inc to run an automotive credit check on my behalf.