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

Initial Here

Co-Applicant's Initial Here

Vehicle Information

Type

Condition

Year

Make

Model

Price

Down Payment

Finance Term

Finance Rate

Your Contact Information

Name As It Appears on Driver's License

First Name

Middle Name

Last Name

Generation

Cell Phone

E-mail

Social Security Number

Date of Birth

Physical Address Information

Physical Address

City

State

Zip

County

Occupation & Housing Information

Do you Rent or Own your home, or other?

Year Residence Established

Banking & Lender Information

Bank Name

Bank Phone

Bank Contact

Lender Name

Lender Phone

Lender Contact Name

Employer Information

Occupation

Year Farming/Business Operation Established

If Not Full-Time Farmer or Other, Occupation

Employer Name

Employer Phone

Year Hired

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

Income & Expenses

Monthly Gross Income

Monthly Housing Expenses

Monthly Credit/Loan/Lease Payments

Joint Applicant Contact Information

First Name

Middle Name

Last Name

Generation

Cell Phone

E-mail

Social Security Number

Date of Birth

Joint Physical Address Information

Physical Address

City

State

Zip

County

Joint Applicant Occupation & Housing Information

Do you Rent or Own your home, or other?

Year Residence Established

Joint Applicant Banking & Lender Information

Bank Name

Bank Phone

Bank Contact

Lender Name

Lender Phone

Lender Contact Name

Joint Applicant Employer Information

Occupation

Year Farming/Business Operation Established

If Not Full-Time Farmer or Other, Occupation

Employer Name

Employer Phone

Year Hired

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 Income & Expenses

Monthly Gross Income

Monthly Housing Expenses

Monthly Credit/Loan/Lease Payments

References

Name

Relationship to You

Phone

City

State

Name

Relationship to You

Phone

City

State