Seller: San Clemente Auto Rental & Sales Inc. 824 N. El Camino Real San Clemente, CA 92672 _____________________________________ _____--_____--_____ _________________ Last Name (Print) First Initial Social Security No. Drivers Lic. No. _____/_____/_____ __________________ (____)_____________ (____)___________ Birthdate E-Mail Address Cell Phone Home Phone _________________________________________________________ ________________ Address City State Zip How Long? (yrs/mos) _________________________________________________________ ________________ Previous Address City State Zip How Long? (yrs/mos) _________________________________________________________ ________________ City State Zip How Long? (yrs/mos) _________ ______________________________________________ (____)___________ Occupation Present Employer Address Work Phone _________ ______________________________________________ (____)___________ Occupation Previous Employer Address Work Phone _________ ______________________________________________ (____)___________ Occupation Previous Employer Address Work Phone __________________________________________________________ (____)___________ Nearest Relative Not Living With Applicant Address Phone |
| Income: Applicant's Gross Monthly Income from Employment.............................................. $ _______________ Alimony, Child Support or Separate Maintenance Income need not be revealed if you wish to have it considered as a basis for repaying this obligation. Received Under: Court Order _____ Written Agreement _____ Verbal Understanding _____ ............................................................................................................................................ $ ________________ Amount of Other Monthly Income and Source(s)......................................................$ ________________Total Monthly Income.....................................................................................................$ ________________ |
| Co-Applicant Income: Joint Applicant's Monthly Income from Employment...............................................$ _________________ Alimony, Child Support or Separate Maintenance Income need not be revealed if you wish to have it considered as a basis for repaying this obligation. Received Under: Court Order _____ Written Agreement _____ Verbal Understanding _____ .......................................................................................................................................... $ _________________ Amount of Other Monthly Income and Source(s)....................................................$ _________________Total Monthly Income....................................................................................................$ _________________ |
_____________________________________________________________________________ Landlord or Mortgage Holder (Own or Rent) Address __________ $_____________ $______________ _____/_____/______ _______________ Account No. Mortgage Balance Payment or Rent Date Home Purchased Age of Home $________________ $________________ $________________ $___________________ Price Paid for Home Market Value 2nd Mortgage Amount Payment 1.)_______________________ ________________________ _______________________ Type of Credit Co. Name of all Obligations Account No. (open/closed) _____________________________ $_____________ $______________ $______________ Address Balance High Monthly Pymts 2.) _______________________ ________________________ ______________________ Type of Credit Co. Name of all Obligations Account No. (open/closed) _____________________________ $_____________ $______________ $______________ Address Balance High Monthly Pymts 3.)_______________________ ________________________ ______________________ Type of Credit Co. Name of all Obligations Account No. (open/closed) _____________________________ $_____________ $______________ $______________ Address Balance High Monthly Pymts 4.)_______________________ ________________________ ______________________ Type of Credit Co. Name of all Obligations Account No. (open/closed) _____________________________ $_____________ $______________ $______________ Address Balance High Monthly Pymts ____________________________ __________ ____________________ $______________ Present Vehicle Financed/ Leased By: Account No. Address Monthly Pymts ____________________________ __________ ____________________ $______________ Present Vehicle Financed/ Leased By: Account No. Address Monthly Pymts ____________________________ __________ ____________________ $______________ Bank Reference Account No. Branch/ Address Balance ____________________________ __________ ____________________ $______________ Bank Reference Account No. Branch/ Address Balance Have you ever had any property repossessed?..................................................................................... (yes/no) Do you have any law suits pending against you?..................................................................................(yes/no) Have you ever filed bakruptcy or is a bankruptcy proceeding in progress or expected?................(yes/no) Military Reserve?..........................................................................................................................................(yes/no) ............................... ............................................................................................................................(active/inactive) 1.)____________________________________________________________ (____)__________ Personal Friends Known Over One Year Address Phone 2.)____________________________________________________________ (____)__________ Personal Friends Known Over One Year Address Phone |
| Purchaser Hereby Acknowledges Receipt of a
Copy of this Credit Statement. X______________________________________________________________________________ Applicant's Signature Co-Applicant's Signature Means you Intend to Apply for Joint Credit. X______________________________________________________________________________ Co-Applicant's Signature |
| In the following sentence, the applicant/co-applicant is
referred to as "I" and the creditor is referred to as "you and your".
I, the undersigned (1) make the above representations, which are
certicfied correct, for the purpose of securing credit; (2) authorize
financial institutions to obtain consumer credit reports on me
periodically and to gather employment history as they consider
necessary and appropriate; (3)
authorize your affiliates to obtain consumer credit reports on
me. I AUTHORIZE THE DEALER'S ASSIGNEE TO SHARE AND USE
INFORMATION ABOUT ME, INCLUDING INFORMATION IN MY APPLICATION, WITH
OTHER ENTITIES THAT ARE RELATED TO IT BY COMMON OWNERSHIP OR AFFILIATED
WITH IT BY COMMON CONTROL. Understand, that you or any
financial institution to whom it is submitted will retain this
application whether or not it is approved, and that it is the
applicant's responsibility to notify the creditor of any changes of
name, address or employment. Financial institutions may be requested to
purchase a sales finance contract written, or to be written, in
connection with your purchase. You are notified pursuant to the
Fair Credit Reporting Act, that your application may be submitted to
them or to other financial institutions. |