Credit Application

Section B :

• Landlord Or Mortgage Holder Name *
• Status * Own Rent
• Monthly Rent or Mortgage Payment *

Section C :

• Have you ever had any property repossessed? * Yes No
• Do you have any lawsuits pending against you? * Yes No

• Have you ever filed bankruptcy or is a bankruptcy proceeding in progress or expected? * Yes No
• Military Reserve * Yes No Active Inactive

• Personal Friends Known for over One Year (1) *
• Phone *

• Address *

• City *
• State *
• Zip *

• Personal Friends Known for over One Year (2) *
• Phone *

• Address *

• City *
• State *
• Zip *

• Nearest Relative Not Living with Applicant *
• Phone *

• Address *

• City *
• State *
• Zip *

• Relationship *

• In the following sentence, the applicant/co-applicant is referred to as "I" and the creditor is referred to as "you and your", I, undersigned (1) make the above representations, which are certified correct, for the purpose of securing credit; (2) authorize financial institutions to obtain consumer credit reports on me periodically and to gather employment history as they consider necessary and appropriate; (3) authorize your affiliates to obtain consumer credit reports on me; (4) I authorize the dealer's assignee to share and use information about me, including information in my application, with other entities that are related to it by common ownership or affiliated with it by common control. You are notified pursuant to the Fair Credit Reporting Act, that your application may be submitted to any financial institution that is affiliated with Custom Leasing & Sales and Auto Dealers that they may deal with.

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