Finance With Andrei (Joint)

First Name

Middle Name

Last Name

Suffix

Residence Address Line 1

Apt #

City

State Abbreviation

Zip Code

Time at Address (Years)

Date of Birth

Social Security #

Please include dashes

Phone

Drivers License State (Abbreviation)

Mortgage/Rent Payment Per Month

Residence Type

Suffix Employer Per

Email

Confirm Email

Employer

Job Title

Employment Type

Gross Monthly Income

Time At Job (Years, Months)

Work Phone Number

Additional Income Amount Per Month

Source of Additional Income

Co-Applicant First Name

Co-Applicant Middle Name

Co-Applicant Last Name

Co-Applicant Suffix

Co-Applicant Residence Type

Co-Applicant Address Line 1

Co-Applicant Apt #

Co-Applicant Address City

Co-Applicant Address State (Abbreviation)

Co-Applicant Address Zip

Co-Applicant Time At Address (Years)

Co-Applicant Date of Birth

Co-Applicant Social Security #

Please include dashes

Co-Applicant Phone Number

Co-Applicant Email

Co-Applicant Drivers License State (Abbreviation)

Co-Applicant Mortgage/Rent Payment Per Month (if applicable)

Co-Applicant Employment Type

Co-Applicant Employer

Co-Applicant Employment Title

Co-Applicant Gross Monthly Income

Co-Applicant Time At Employer (Years)

Co-Applicant Employer Phone Number

Co-Applicant Additional Income Amount Per Month

Co-Applicant Source of Additional Income

Trade-In Year

Trade-In Make

Trade-In Model

Trade-In VIN

Trade-In Mileage

Trade-In Color

Trade-In Lienholder

Trade-In Payoff Amount

Trade-In Title Status

Applicant E-Signature

Co-Applicant E-Signature

Today's Date

Disclosure: I (each applicant) understand that my application will be shared with the dealer as well as third party financing entities. I understand that you, and/or your assignees may retain this application and any other information you receive whether or not the application is approved. For purposes of this application, you are authorized to check my credit and employment history. I authorize any person or consumer reporting agency to furnish to you any information it may have or obtain in response to credit inquiries, whenever you make them. I understand this partial application may not provide sufficient information to make a credit decision. If this occurs, I agree to provide the additional information required to the dealer. If I do not provide this information, I understand my application will be incomplete. I also understand that further information may be requested by you, the dealer, or any third party entities that provide credit. In order to successfully transmit and receive the information and disclosures related to this credit application, I understand I must have an active Internet connection, a browser capable of sending and receiving secure information and the ability to print pages from this Web site for my records. I consent to receive the information, follow-up communications, and disclosures related to this credit application and any subsequent credit transaction from you, your affiliates, agents and service providers, in writing, verbally, or electronically. This consent includes, but is not limited to, contact by manual calling methods, prerecorded or artificial voice messages, text messages, emails and/or automatic telephone dialing systems using any e-mail address or any telephone number I provide, now or in the future, including a number for a cellular phone or other wireless device, regardless of whether I incur charges as a result. I agree that you, your affiliates, agents and service providers may monitor and record telephone calls regarding this credit application and any subsequent credit transaction to assure the quality of your service or for other reasons. I understand that each time I submit a credit application, a notice will be placed on my credit report. I certify that the information that I submit with this application is true and complete to the best of my knowledge. I further certify that I am not contemplating a bankruptcy action at the present time, nor do I have any executions or pending legal proceedings against me. I recognize that providing false or fraudulent information is illegal and may be a basis for denying a discharge in bankruptcy. I further certify that I have attained the age of majority.

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