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First Name MI Last Name
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DOB SS# Home Phone
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Home Address
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City State ZIP
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Employer's Name
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Position Gross Monthly Salary Work Phone
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Best Time to Contact
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Which vehicle are you most interested in?
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Do you have a vehicle you wish to trade in? If so, please tell us about it.
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I/We hereby certify that the foregoing statements are true and complete and are
made for the purpose of determining my/our eligibility for credit. I/We agree that this
statement shall remain your property, whether or not the application is accepted.
You are authorized to make all inquiries you deem necessary to verify the accuracy
of the statements made herein, and to determine my/our credit worthiness, including,
but not limited to, procuring consumer reports from consumer reporting agencies and
credit information from banks and other financial institutions and extenders of credit,
references, present and former employers, merchants, landlords, and creditors. Each
applicant consents that upon denial of the application based upon a consumer report
or information received from a person other than a consumer reporting agency on
any applicant creditor may make appropriate Fair Credit Reporting Act disclosures to
all applicants.
YOU MAY CONTACT AND INQUIRE OF MY REFERENCES, CREDITORS, MY
EMPLOYERS, PRESENT AND FUTURE, AND VISIT AND/OR TELEPHONE MY
HOME CONCERNING CREDIT AND COLLECTION, EITHER BEFORE OR AFTER
THE LOAN IS MADE. I CERTIFY THAT NO ONE HAS SUGGESTED THAT I OMIT
ANY OF MY INDEBTEDNESS FROM THIS STATEMENT TO THE EXTENT
PERMITTED BY THE LOUISIANA CONSUMER CREDIT LAW. I HEREBY WAIVE
ANY PRIVILEGED COMMUNICATIONS I MAY HAVE WITH ANY AND ALL PERSONS
NAMED.
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