Credit Application | Atlantic Auto Remarketing, Inc.

PERSONAL INFORMATION:

First Name:

Last Name:

Home Phone:

Day Phone:

E-Mail:

Address 1:

Address 2:

City: State: Zip Code:

Social Security #: Date of Birth: Month Day Year:

Do you rent or own?

Monthly Payment $

Time at Residence: Years Months

PREVIOUS RESIDENCE INFORMATION:

Address 1:

Address 2:

City: State: Zip Code:

Time at Previous Residence: Years: Months:

FINANCIAL INFORMATION:

Desired Downpayment Amount:

Are You Self-Employed?
Yes
No

If yes, can you provide 3 months of Bank Statements?
Yes
No

EMPLOYMENT INFORMATION:

Employer:

Your Title:

Time Employed: Years: Months: Monthly Income:

Business Phone: (xxx) xxx-xxxxx

Address 1:

Address 2:

City: State: Zip Code:

PREVIOUS EMPLOYER INFORMATION:

Employer:

Time at Previous Job: Years: Months:

Business Phone: (xxx) xxx-xxxxx

Address 1:

Address 2:

City: State: Zip Code:

ADDITIONAL INCOME INFORMATION:

Source 1: Monthly Income:

Source 2: Monthly Income:

Source 3: Monthly Income:

Do you have Georgia Driver's License? Yes No

Have you ever filed for Bankruptcy? Yes No

Are you still in Bankruptcy? Yes No

Have you ever had a Repossesion? Yes No

How many times? 0 1 2 More

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