Finance

Applicant Information

Last Name (required)

First Name (required)

Middle Initial (required)

Date of Birth (required)

SSN (required)

Phone Number (required)

Current Address (required)

Email Address (required)

City (required)

State (required)

Zip Code (required)

Rent or Own?
RentOwn

Monthly Mortgage/Rent Amount (required)

Since Date (mm/dd/yyyy)(required)

Previous Address (if less than 3 months at current)

City

State

Zip Code

Since Date (mm/dd/yyyy)(required)

Do you have an existing bank account?
YesNo

Name of Your Bank?

Type of Account (checking, savings, prepaid card, etc.)?

Employment Information

Current Employer (required)

Employer Phone (required)

Employer Address

Date of hire (mm/dd/yyyy) (required)

City (required)

State (required)

Zip Code(required)

Position

Hourly Pay

Monthly Pay (if salaried)

Previous Employer (if less than 3 mo. at current job)

Date of hire (mm/dd/yyyy) (required)

Position

Phone

Co-applicant Information (if for a joint account)

Relation to Applicant

Last Name

First Name)

Middle Initial

Date of Birth

SSN

Phone Number

Current Address

Email Address

City

State

Zip Code

Rent or Own?
RentOwn

Monthly Mortgage/Rent Amount

Since Date (mm/dd/yyyy)

Previous Address (if less than 3 months at current)

City

State

Zip Code

Since Date (mm/dd/yyyy)

Do you (co-applicant) have an existing bank account?
YesNo

Name of Your Bank?

Type of Account (checking, savings, prepaid card, etc.)?

Co-applicant Employment Information

Current Employer

Employer Phone

Employer Address

Date of hire (mm/dd/yyyy)

City

State

Zip Code

Position

Hourly Pay

Monthly Pay (if salaried)

Previous Employer (if less than 3 mo. at current job)

Date of hire (mm/dd/yyyy)

Position

Phone

Additional Applicant Information

Current Auto Loans (list below)

Account Number (list below)

Account Balance (list below)

Monthly Payment (list below)

For the purpose of securing credit, by signing below and clicking Send Application below, I along with any Co-applicant (if applicable), certify that the above information is true and complete to the best of my knowledge AND authorize B & M Auto Sales to check my/our credit, residence, and employment history, as needed and to provide and/or obtain information about my credit experiences.

signature here (use mouse)