* Required Field

Applicant's Information

First Name *		MI	Last Name *
E-Mail *		Phone *		Fax
Birth Date *		Social Security # *
Mother's maiden name		* Single Married Separated
Driver License Number *		State of Issue * Expiration date *
US Citizen *	Yes No

Primary Residence

Address Line 1 *
Address Line 2
City *	State * Postal Code *

Amount of Time at this Residence: Years * Months * Type of Residence * Own Rent Other

Total monthly housing payment * $		Total years as a homeowner

Previous Residence
(If less than 2 years at current residence)

Mailing Address
(If different than primary address)

Nearest Relative (not living with you)

Name *
Address Line 1 *
Address Line 2
City *	State * Postal Code *
Phone Number *	Relationship *

Current Employment

Occupation	Employer
Payment Type	Hourly Salary Other
Hire Date
Work Phone
Self-Employed?	Yes No
Gross Monthly Income $	Monthly
How long employed by this employer? Years Months
Address Line 1
Address Line 2
City	State Postal Code

Previous Employment
(If less than 2 years at current employment)

Financials

Other Monthly Income $
Please list other income sources

Checking Account? *	Yes No / Current Balance * $
Savings Account? *	Yes No / Current Balance * $

Bank Name

Do you receive or pay child support? * No Receive Pay

Other liquid assets $
Please list other liquid asset sources

Are you in the middle of a bankruptcy? * Yes No

Have you filed for bankruptcy in the last 5 years? * Yes No

Net Income (or take home money per month) *

Please Check * I, the Applicant, certify that all of the statements in this application are true and complete and are made for the purpose of obtaining credit.

Do you Have a Co-Applicant? (co-buyer, co-signer) Yes No

Do you have a vehicle you plan to trade in? Yes No

Loan Details

If you are unsure of the details of your loan then a representative will contact you to aid you in completion of this or any section that you request.

Check Here If you would like a representative to contact you.

Vehicle To Be Purchased

Seller: Select Motors, 603 Amelia Street, Plymouth, MI phone: 800-634-8370
Link: autos.php?te_class=autos&te_mode=view&te_key=1261

ListingID		LocationID		License Number		Stock Number

VIN

Mileage

Make

Model

Model Year

Down Payment * $		Total Vehicle Cost * $
Payment Amount * $

Questions / Comments?

POLICY
(you are required to read this)

By clicking the button below, you certify that all of the statements in this application are true and complete and are made for the purpose of obtaining credit. You authorize this website to share the application and related information with its lending partners in order to complete the processing of this application. You authorize this website and its lending partners to retain and rely on this application, and obtain additional information, including credit reports.

Type your name to signify your electronic signature

Applicant's Signature * x

And please check * I have read and accept the above policy.