Credit Application

Akira Auto > Credit Application

PLEASE FILL OUT ALL REQUIRED FIELDS " * "

FIRST NAME: *

LAST NAME: *

DATE OF BIRTH: *

# OF DEPENDENTS: *

STREET ADDRESS: *

CITY: *

STATE: *

ZIPCODE: *

HOW LONG IN STATE?: *

HOME PH:

CELL PH: *

YOUR EMAIL: *

RESIDENTIAL STATUS: *
OWNRENT

MONTHLY RENT/MORTGAGE PMT: *

LANDLORD/MORTGAGE HOLDER NAME: *

PREV ADDRESS (IF LESS THAN 2 YR):

CURRENT EMPLOYER'S NAME: *

CURRENT EMPLOYER'S ADD: *

GROSS MONTHLY SALARY: *

WORK PH: *

OCCUPATION/JOB TITLE: *

HOW LONG?: *

PREVIOUS EMPLOYER'S NAME (IF LESS THAN 2 YR):

HOW LONG?:

OTHER INCOME NOTE:

ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOMES DO NOT HAVE TO BE REVEALED UNLESS THE APPLICANT WISHES TO HAVE SUCH SOURCES CONSIDERED AS A BASIS FOR REPAYMENT OF THE REQUESTED CREDIT AMOUNT.

GROSS MONTHLY OTHER INCOME:

OTHER INCOME SOURCE:

REFERENCE 1:

REFERENCE 1 PH:

REFERENCE 2:

REFERENCE 2 PH:

DOWN PAYMENT: *

ANTICIPATED MONTHLY PAYMENT: *

FAIR CREDIT REPORTING ACT TO CONSUMER

THIS WILL ADIVSE YOU THAT YOUR RETAIL INSTALLMENT SALES CONTRACT AND BUYER’S APPLICATION FOR SECURED DEBT WILL BE SUBMITTED TO FINANCIAL INSTITUTIONS AND THEIR AFFILIATES FOR PURCHASE AND CONSIDERATION AS TO WHETHER YOU MEET THEIR CREDIT REQUIREMENTS.

THE UNDERSIGNED FURTHER AUTORIZES THESE FINANCIAL INSTITUTIONS AND THEIR AFFILIATES TO OBTAIN SUCH INFORMATION THAT THEY MAY REQUIRE IN ORDER TO VERIFY INFORMATION RELATIVE TO THIS REQUEST INCLUDING CONTACTING SPOUSES TO VERIFY SPOUSE RELATED INFORMATION.

I CERTIFY THAT ALL INFORMATION GIVEN BY ME ON THIS APPLICATION IS COMPLETE AND ACCURATE. I GIVE MY PERMISSION FOR ANY FINANCIAL INSTITUTION WHICH WILL REVIEW THIS CREIDT APPLICATION, TO INVESTIGATE MY CREDIT AND EMPLOYMENT HISTORY, AND TO ANSWER QUESTIONS ABOUT THEIR CREDIT EXPERIENCE WITH ME INCLUDING BUT NOT LIMITED TO LATE PAYMENTS, MISSED PAYMENTS OR OTHER DEFAULTS, AND THIS INFORMATION MAY BY REPORTED
IN YOUR CREIDIT REPORT.