Please fill out the following form for credit check.
Personal
Information:
Last Name
First
Name
Middle
Initial
Date of Birth
Social Security Number
-
Driver's
License No.
Mother's
Maiden Name
Present
Address:
Number and Street
City
State
Zip
Code
Yrs.
Mos.
Lived
There
Home Phone
Number
Cell Phone
Number
Previous
Address:
Number and Street
City
State
Zip
Code
Yrs.
Mos.
Lived
There
Landlord or
Mortgage Holder Information:
Land
Lord or Mortgage Holder Name
$
Rent or Mortgage Payment
Move-in Date
Type of Mortgage
Phone
Number
Employment &
Income Information:
Current
Employer Name
City
State
Applicant's
Occupation
Yrs.
Mos.
Worked
There
/
Hire Date
(month/year)
$
-
Gross
Salary
Yes
No
Temporary Employee
Work Phone Number
$
Other
Income
Source
of Other Income
Previous
Employment:
Previous
Employer Name
City
State
Applicant's
Occupation
Yrs.
Mos.
Worked
There
Work
Phone Number
Financial/Bank
Information:
Name of Bank
Bank Account Type
Are you current
on your Rent or Mortgage?
Yes
No
Have you ever a
Car or Other Merchandise Repossessed?
No
Yes - Date:
/
(month / year)
Have you ever
Filed Bankruptcy?
No
Yes - Date:
/
(month / year)
Reference
Information:
Name of the Auto Mall 59 Sales Representative:
How Did you
Hear about us:
Electronic Signature:
Click
on the box below to sign this form electronically. By
submitting this form, you are authorizing Auto Mall 59 to access and review your credit history and verify your
employment.
