I am applying for (please
check the appropriate box):
___
Individual
___ Individual with one
or more co-applicant (i.e., one parent or
co-signer
___ Joint
(applicant & spouse)
___ Joint
applicants with an individual and one or more
co-applicant |
|
PRIMARY
APPLICANT'S INFORMATION |
| First Name |
____________________ |
Social Security
Number |
____________________ |
| Middle Initial |
______ |
Driver's License
Number |
____________________ |
| Last Name |
____________________ |
Date of Birth
(mm/dd/yy) |
____________________ |
| Generation |
_________ |
(Check one)
Married ___
Unmarried___ Separated___ |
|
|
Number of Dependents
____________ |
|
Has applicant or spouse ever obtained credit
under a different name? Yes ___
No ___ |
|
If Yes, Show Name(s) separated by commas :
_____________________________________________ |
|
Will applicant be principal driver or
operator? Yes ___ No ___ If no,
list names of other parties: |
|
Name: ____________________
Relationship to Applicant: ________________
Age: _________ |
| Applicant's
Present Street Address
________________________________ Apt. Number
_________ |
|
City: _________________________ State:
_______________ Zip: ________________ |
| How Long?
Years ______ Months ______ |
Home Phone
Number _____ _________________ |
|
(Check One)
___Rent ___Own ____Mobile Home ____ Living
with Parents
|
|
Monthly Rent or Mortgage
Payment
________________ |
Landlord or Mortgage Holder's
Name
______________________________________ |
| Former
Address:
_________________________
How Long? Years
____ Months ____ |
| |
|
PRIMARY
APPLICANT'S EMPLOYMENT |
| Current
Employer:
___________________________
Self-Employed _______ |
| City:
_____________________ State:
________________ Zip: _________________ |
| How Long?
Years _______ Months ________ |
Business Phone
Number ____ _____________ |
| Occupation (If
Military, Rank, ETS)
__________________________________________________ |
| (Note:
Alimony, child support, or separate maintenance income need
not be revealed unless you want us to consider it in granting
credit):
Gross Monthly Salary
$________________
Other Income $_________________ |
| Source of
other income: ___________________________ |
| Former
Employer ____________________________ How
Long? Years _______ Months _______ |
| City:
___________________
State: ______________ Zip: ______________ |
| |
If you live in
a community property state you must provide your spouse's
information below even though your spouse may not be signing
this application and agreement.
|
|
SPOUSE'S
INFORMATION |
| First Name |
____________________ |
Social Security
Number |
____________________ |
| Middle Initial |
____ |
Driver's License
Number |
___________________ |
| Last Name |
____________________ |
Date of Birth
(mm/dd/yy) |
___________________ |
| Generation |
__________ |
|
| |
|
SPOUSE'S
EMPLOYMENT |
| Current
Employer:
_________________________
Self-Employed _________ |
| City:
___________________ State:
_______________ Zip: ________________ |
| How Long?
Years ______ Months ________ |
Business Phone
Number ____ _____________ |
| Occupation (If
Military, Rank, ETS)
__________________________________________________ |
| (Note:
Alimony, child support, or separate maintenance income need
not be revealed unless you want us to consider it in granting
credit):
Gross Monthly Salary
$________________
Other Income $__________________ |
| Source of
other income: ________________________________ |
| Former
Employer ___________________ How Long?
Years ______ Months _______ |
| City:
_____________________ State:
_________________ Zip: ______________ |
| |
| PERSONAL REFERENCES |
| Nearest
relative not living with you:
________________________ Relationship
__________________ |
| Address
________________________________________ |
| City:
________________ State:
_________________ Zip: __________________ |
| Phone Number:
_______________________ |
|
Close Friend
__________________________________ |
| Address
_____________________________________ |
| City:
_________________ State:
_________________ Zip: _________________ |
| Phone Number:
_________________________ |
| |
|
FINANCIAL
INFORMATION
Include Joint Applicant's
Information |
| Savings/Money
Market Institution Name |
________________________________________ |
| Checking's
Institution Name |
________________________________________ |
| |
|
MAJOR CREDIT
CARDS |
| MasterCard
Institution/Bank Name |
______________________________________ |
| Visa
Institution/Bank Name |
______________________________________ |
| American
Express Institution/Bank Name |
______________________________________ |
| Other Cards
Institution/Bank Name |
______________________________________ |
| |
|
|
DEPARTMENT STORE
CREDIT CARDS |
| Store 1
Name |
____________________________________ |
| Store 2
Name |
____________________________________ |
| Store 3
Name |
____________________________________ |
| |
|
TYPE OF OTHER
CREDIT |
|
Institution Name |
|
| Auto
__________________________ |
Monthly
Payment ______________ |
| Bank
__________________________ |
Monthly
Payment ______________ |
| Credit
Union
_________________________ |
Monthly
Payment _______________ |
| |
| I certify that
the statements above, on the reverse, or on any attachment are
true and complete. I understand that AHFC will be asked
to buy the contract involved in this sales transaction.
I authorized the seller and AHFC to; check the information on
this application, verify my employment, check my credit
references with credit bureaus and others, and request
additional information from them, including a credit
report. AHFC may give information about how I have
handled this account to credit bureaus or others who may
lawfully receive such information. I authorize AHFC to
give a copy of this application to anyone who has agreed to
pay debts incurred on the basis of this application. I
authorized AHFC to communicate the reason(s) for action taken
on this application to the dealer named above.
Has applicant or spouse voluntarily surrendered or has a
vehicle, or any
other item
repossessed? ____
Yes ____ No |
| Has applicant
or spouse ever been the subject of bankruptcy
proceedings? ____ Yes ____
No |
Can the credit
references and/or history of applicant or spouse be verified
in any other name?
___
Yes _____
No If Yes, what
name(s)? __________________________________ |
| |
| Notice for
Ohio Residents: The Ohio laws against discrimination
require that all creditors make credit equally available to
all creditworthy customers, and that credit reporting agencies
maintain separate credit histories on each individual upon
request. The Ohio Civil Rights Commission administers
compliance with this law.
Notice for Married Wisconsin Residents: No
agreement, unilateral statement or court decree relating to
marital property adversely affects a creditor's interest
unless prior to the time credit is granted the creditor is
furnished a copy of the agreement, statement or decree, or has
actual knowledge of the adverse provision.
Notice to Illinois Residents: Residents of
Illinois may contact the Illinois Commissioner of Banks &
Trust Companies, (800) 634-5452, for comparative information
on interest rates, charges, fees and grace periods.
Notice to Maine and New York Residents:
Consumer reports (credit reports) may be obtained in
connection with this credit application. If you request,
1) You will be informed whether or not consumer reports were
obtained: and 2) If reports were obtained, you will be
informed of the names and addresses of the consumer reporting
agencies (credit bureaus) that furnished the reports.
Applicant's Signature
_______________________
Date ________________________
Joint Applicant's Signature
_______________________
Date _____________________ |