LBCAuto Sales Secure Loan Application Form

Desired Loan Amount:

Desired Monthly Payment:

PERSONAL

Name:

First Name

Last Name

Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Daytime Phone:

(###)

###

####

Evening Phone:

(###)

###

####

Fax:

(###)

###

####

Email Address:

Social Security Number:

Birthday:

YYYY

Mortgage/Rent Payment:

Per month

Residence Type

Time at Residence:

If you have lived at your current residence less than 5 years, please enter your prior address:

Which Accounts are in Your Name:

Utilities

Savings

Checking

Phone

Drivers License Number:

Drivers License State:

Driver Lic. Exp Date:

YYYY

EMPLOYMENT:

Employer Name:

Employer Address:

Employer State

Business Phone:

(###)

###

####

Occupation:

Employment Status:

Time on Job:

How often are you paid?

How much per paycheck?

Other Income:

Consent

I agree that by submitting this application, I authorize and give this dealership, as well as any potential financing source this dealership presents this application to, my consent to obtain my credit report from any credit reporting agency used to complete an investigation of my credit.

VEHICLE INFORMATION

Vehicle Make:

Vehicle Model:

Vehicle Year:

Vehicle Mileage:

Down Payment Amount: