Secure Finance Application

Statement of Consent

I certify that the information provided by me is correct. I also understand that you will be checking with credit reporting agencies. I authorize an investigation of my credit and employment history and the release of information about my credit experience.

Please initial below to indicate that you have received a copy of our Privacy Notice and agree to all of the above.

YOUR CREDIT APPLICATION IS GOING THROUGH A SECURE WEBSITE AND YOUR IDENTITY IS SAFE

**ALONG with your application please send via Email to elva@triplejs.net: Driver's License/State ID or Passport, last 2 paycheck stubs, 2 utility receipts in your name, proof of income from last year, and lease agreement.

Initial Here

Co-Applicant's Initial Here

Vehicle Information

Type

Year

Make

Model

Your Contact Information

Name As It Appears on Driver's License

First Name

Middle Name

Last Name

Driver's License

Work Phone

Cell Phone

E-mail

Social Security Number

Male / Female

Date of Birth

Marital Status

Spouse Name

Spouse Income

Physical Address Information

Physical Address

City

State

Zip

County

Housing Information

Do you Rent or Own your home, or other?

LandLord / Mortgage Holder

Rent / Mortgage Monthly Amount

Mortgage Balance

Time at Current Residence

Previous Residence (If less than 2 years at Current Residence...)

Address

City

State

Zip

How long at Previous Residence

Banking Information

Have you been declared bankrupt in the last 14 years?

If yes where?

Year

Have you had any Repossession in the last 2 years?

If yes where?

Year

Any Unsatisfied Judgements against you?

Amount

To whom

Year

Are you a co-maker, endorser or guarantor on any loan or contract?

If yes, whom

Have you consulted with an attorney about filing Bankruptcy?

Are you contemplating filing Bankruptcy?

Employer Information

Occupation

Employer Name

Employer Address

Employer City

Employer State

Employer Zip

Employer Phone

Salary (Annually Gross)

Time at Employer

Type of Employment

Other Income

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.

Alimony, child support, separate maintenance received under, court order_ written agreement_ oral understanding.

Other Income Frequency

Previous Employer Information (If less than 5 years at Current Employer...)

Occupation

Employer Name

Employer Address

Employer City

Employer State

Employer Zip

Employer Phone

Salary (Annually Gross)

Time at Employer

Additional Comments

Please include any information that you feel may help us process your application.

Joint Applicant Contact Information

First Name

Middle Name

Last Name

Driver's License

Work Phone

Cell Phone

E-mail

Social Security Number

Date of Birth

Joint Physical Address Information

Physical Address

City

State

Zip

County

Joint Applicant Housing Information

Do you Rent or Own your home, or other?

LandLord / Mortgage Holder

Rent / Mortgage Monthly Amount

Time at Current Residence

Joint Applicant Previous Residence (If less than 2 years at Current Residence...)

Address

City

State

Zip

How long at Previous Residence

Joint Applicant Banking Information

Have you been declared bankrupt in the last 14 years?

If yes where?

Year

If yes where?

Year

Any Unsatisfied Judgements against you?

Amount

To whom

Year

Are you a co-maker, endorser or guarantor on any loan or contract?

If yes, whom

Have you consulted with an attorney about filing Bankruptcy?

Are you contemplating filing Bankruptcy?

Joint Applicant Employer Information

Occupation

Employer Name

Employer Address

Employer City

Employer State

Employer Zip

Employer Phone

Salary (Annually Gross)

Time at Employer

Other Income

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.

Alimony, child support, separate maintenance received under, court order_ written agreement_ oral understanding.

Other Income Frequency

Joint Previous Employer Information (If less than 5 years at Current Employer...)

Occupation

Employer Name

Employer Address

Employer City

Employer State

Employer Zip

Employer Phone

Salary (Annually Gross)

Time at Employer

Joint Applicant Additional Comments

Please include any information that you feel may help us process your application.

References

Name

Relationship

Phone

City

State

Name

Relationship

Phone

City

State

Name

Relationship

Phone

City

State

Name

Relationship

Phone

City

State

Acknowledgement 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 request for credit. False statements may subject me to criminal penalties. I authorized 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 that creditor to give credit information about me to its affiliates.