Contact Information Email Address Last Name First Name Middle Name Date of Birth Social Security Number Drivers License Number Present Address Street City State Zip Code County Do you...... Select One Own Home Outright Buying Home Renting or Leasing Live with parents or relatives How long lived there? Monthly Payment Phone Number Employment Current Employer Name City State Occupation Work Phone Gross Monthly Income Time on Job Down Payment Available Will there be a trade-in? Select One Yes No Maybe Read this before submitting application ACKNOWLEDGMENT 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. DO YOU UNDERSTAND AND AGREE TO THE ABOVE ACKNOWLEDGEMENT? Select One Yes No I authorize Hebersprings Ford to start a credit investigation based on the information voluntarily provided by me which is true and correct. A credit report may be obtained in connection with this application, for renewal or extension of credit for which this application was made. Upon request, I will be told if credit report(s) was/were obtained, and given the name and address of the credit reporting agency(ies) providing the report(s). Credit Investigation. Bankruptcy. A bankruptcy proceeding is not in progress nor expected. Copy provided. Upon request, I will be provided with a copy of this application. This form is not to be used for Business Applications or Co-Buyers. DO YOU UNDERSTAND AND AGREE TO THE ABOVE PARAGRAPH? Select One Yes No Typing your name below constitutes your signature and authorizes the processing of this application Signature of applicant Date