Elliott Chevrolet

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Online Credit Application

	I Am the Buyer
	I Am the Co-Buyer / Co-Signer
If you are the Co-Buyer / Co-Signer - Relationship to Buyer - - Name of Buyer - If using CoBuyer / CoSigner, both must fill out their own applications. All information will be verified.
Name of Applicant:
Social Security Number:
Marital Status	Single Married Separated Divorced
Date of Birth
Number of Dependents
Do You Pay Child Support?	No Yes
If so, how much
Address 1
Address 2
City
State
Zip Code
E-mail Address
Home Phone
Cell or Pager
How long at this address?	Years
Own Rent Rent Lot	Amount
Mortgage Comp. or Landlord
If less than 3 years list previous below.

How Long?
Employment Note: 3 Years of Employment History Required
Current Employer
Phone
Address
City
State
Zip Code
Years Employed
Position
Department
Gross Montly Income
Other Income
Please Explain
Previous Employer
Phone
Years Employed
Position
Reason for Leaving
Bank Information
Name of Bank
Location/Branch
Do You Have (check all that apply)	Direct Deposit Checking Account Savings Account Loan with this Bank?
How Much Down Payment if any
Do You Have a Vehicle Now?	Yes No
Will You Be Trading It?	Yes No
Year
Make
Model
Is This Vehicle Financed?	No Yes
If yes, list with whom

By Submitting this application, I am giving Elliott Chevrolet authorization to release any information concerning myself to investigate my credit record and to verify the information given above. I certify that the statements made above are true and correct.

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Last modified: Nov. 19, 2005