|
Applicant
completes this section (Please fill out completely)
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LAST
NAME OR
BUSINESS NAME
|
DATE
OF BIRTH
(MMDDYY)
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/
/
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FIRST
NAME
|
MI
|
SOCIAL
SECURITY N0.
(or TAX ID#)
|
|
|
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CURRENT
STREET NO.
|
CURRENT
STREET ADDRESS (MAILING ADDRESS) |
PO
BOX NO.
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CITY
|
STATE
|
ZIP
CODE
|
|
|
|
|
|
(AREA
CODE ) HOME PHONE
|
OWN
RENT
FAMILY
OTHER
|
MTG
PAYMENT
OR RENT |
TIME
AT ADDRESS
|
|
-
|
|
YRS
MOS
|
|
EMPLOYED
BY or TYPE OF BUSINESS
(if business Application)
|
OCCUPATION
|
|
|
|
|
Alimony,
child support, or separate maintenance income need not be revealed
if you do not wish to have it considered as a basis for repaying
this obligation
|
|
(AREA
CODE ) BUSINESS PHONE
|
GROSS
ANNUAL
INCOME
(ALL SOURCES)
|
TIME
EMPLOYED
|
MILITARY
RANK
|
|
-
|
|
YRS
MOS
|
|
|
Co-applicant
completes this section
|
|
LAST
NAME OR BUSINESS NAME
|
DATE
OF BIRTH
(MMDDYY)
|
|
|
/
/
|
|
FIRST
NAME
|
MI
|
SOCIAL
SECURITY N0.
(or TAX ID#)
|
|
|
|
|
|
CURRENT
STREET NUMBER
|
CURRENT
STREET ADDRESS
(MAILING ADDRESS) |
PO
BOX NUMBER
|
|
|
|
|
|
CITY
|
STATE
|
ZIP
CODE
|
|
|
|
|
|
(AREA
CODE ) HOME PHONE
|
|
MTG
PAYMENT OR RENT |
TIME
AT ADDRESS
|
|
-
|
OWN
RENT
FAMILY
OTHER
|
|
YRS
MOS
|
|
EMPLOYED
BY or
TYPE OF BUSINESS (if business Application)
|
OCCUPATION
|
|
|
|
|
Alimony,
child support, or separate maintenance income need not be revealed
if you do not wish to have it considered as a basis for repaying
this obligation
|
|
(AREA
CODE ) BUSINESS PHONE
|
GROSS
ANNUAL INCOME
(ALL SOURCES)
|
TIME
EMPLOYED
|
MILITARY
RANK
|
|
-
|
|
YRS
MOS
|
|
|
This
application will be submitted to John Walters Auto Credit
Department, so that they may decide whether or not to purchase
the transaction.
|
|
Unless this checkbox is marked, I authorize the dealer, John Walters
Auto and their affiliates to share and use information about
me, including information in my application, with other entities
that are related to them by common ownership or affiliated with
them by common control.
If this
box is checked, I direct the dealer, John Walters Auto and
their affiliates not to share and use information about me (other
than information on their own transactions or experiences with
me).
By checking
this box, I certify that the information in my application is
complete and true. I authorize the dealer, John
Walters Auto to investigate my credit and employment history,
obtain credit reports, and release information about their credit
experience with me. If an account is created, I authorize the
obtaining of credit reports for purposes of reviewing or taking
collection action on the account, or for other legitimate purposes
associated with the account.
|
|
E-MAIL
ADDRESS
|
|
NEAREST
RELATIVE NOT LIVING WITH YOU
NAME
ADDRESS
PHONE
|
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|
