Bloomington
AUTO CENTER
3098 S. Walnut Street
Bloomington, Indiana 47401
(812) 334-2244
Applicant Information
First Name:
Last Name:
Address:
City/State/Zip:
Social Security:
Date of Birth:
Phone Number:
Email:
Years:
Months:
Time at Residence:
Residence Type:
Rent/Mortgage Amount:
Applicant Previous Residence -
Complete if you've been at your current Residence for less than 2 years.
Address:
City/State/Zip:
Phone Number:
Time at Residence:
Years:
Months:
Residence Type:
Rent/Mortgage Amount:
Applicant Employment Information
Employer:
Monthly Income:
Occupation:
Address:
City/State/Zip:
Work Phone:
Years:
Months:
Time on Job:
Applicant Previous Employer -
Complete if you've been at your current employment for less than 2 years.
Employer:
Monthly Income:
Occupation:
Address:
City/State/Zip:
Work Phone:
Months:
Time on Job:
Years:
Vehicle Information
Stock Number:
Year:
Make:
Model:
VIN:
Mileage:
Sale Price:
Financing Information
Financing Preferred:
Loan Term (Months):
Amount Required:
Down Payment:
Trading in Vehicle?
Trade Year:
Trade Make:
Trade Model:
Trade Mileage:
Trade Payoff:
Trade-In Allowance:
Additional Comments
Acknowledgement and Consent:
I certify that the above information is complete and accurate to the best of my knowledge. Creditors
receiving this application will retain the application whether or not it is approved. Creditors may rely on
this application in deciding whether to grant the requested credit. False statements may subject me to
criminal penalties. I authorize the creditors to obtain credit reports about me on an ongoing basis
during this credit transaction and to check my credit and employment history on an ongoing basis
during the term of the credit transaction. If this application is approved, I authorize the creditor to give
credit information about me to its affiliates.
