CREDIT APPLICATION REQUEST 


General Information
First Name: *  
Last Name: *  
Email: *  
Social Security #: *   Ex. 123-45-6789
Birthdate: *  Ex. 08/14/1969
Drivers License #:*      State: Ex. NY
Address: * 
City: * 
State: * 
Zip Code: * 
Home Phone: *  Ex. 404-555-1212
Time at Residence:   Years     Months
Residence Type:  
Rent/Mortgage: *$

 

Financing Information
Banking Type:  
Financing Preferred:  
Loan Term (Months):  
Amount Required: $
Time of Purchase:  
Downpayment: $

Which Vehicle are you interested in purchasing?

 
Trading in Vehicle? 
Year:  
Make:  
Model:  
Mileage:  
Estimated Payoff: $

 

Employment Information
Employer: * 
Gross Monthly Income: *$
Occupation: * 
City/State/Zip: * 
Work Phone: *  Ex. 404-555-1212
Time on Job:   Years     Months
Other Income Source:  
Gross Amount: $

ACKNOWLEDGMENT AND CONSENT: I certify that the above information is complete and accurate to the best of my knowledge. Creditors receiving this application will retain the application whether or not it is approved. Creditors may rely on this application in deciding whether to grant the requested credit. False statements may subject me to criminal penalties. I authorize the creditors to obtain credit reports about me on an ongoing basis during this credit transaction and to check my credit and employment history on an ongoing basis during the term of the credit transaction. If this application is approved, I authorize the creditor to give credit information about me to its affiliates.

 

 
Plony's Auto Merchants Ltd.
6165 South Bay Rd.
Cicero, NY 13039		 Phone: (315) 699-3900 or
Toll Free 1-877-275-6697
Fax (315) 699-3232
E-mail Us!!!