Credit Application

Please enter the following information to start the application process. Be sure to provide complete and accurate information. The following form is submitted over a secure connection and is encrypted for your security.

Applicant Information

Dealership Location: CorinnaVeazie

First Name:

Middle Initial:

Last Name:

Social Security #

Birthdate:

Phone:

Drivers License #

Email Address:

Current Physical Address:

City:

State:

Zip:

How Long?

Current Mailing Address:

City:

State:

Zip:

How Long?

Employment and Income

Current Employer:

Phone:

Hire Date:

Address:

City:

State:

Zip:

Job Description:

Hours Worked:

Supervisor's Name:

Phone:

Former Employer Name: (If worked here within the past 2 years)

Phone:

How Long?

Address:

City:

State:

Zip:

Co-Applicant Information

First Name:

Middle Initial:

Last Name:

Social Security #

Birthdate:

Phone:

Drivers License #

Email Address:

Current Physical Address:

City:

State:

Zip:

How Long?

Current Mailing Address:

City:

State:

Zip:

How Long?

Co-Applicant Employment and Income

Current Employer:

Phone:

Hire Date:

Address:

City:

State:

Zip:

Job Description:

Hours Worked:

Supervisor's Name:

Phone:

Former Employer Name: (If worked here within the past 2 years)

Phone:

How Long?

Former Employer Address:

City:

State:

Zip:

Credit Information

Do you own or rent?

Own

Rent

Name of Creditor or Landlord:

Landlord's Address:

Landlord's Phone:

Directions to your home:

Family References

Nearest Relative Not Living With You

Phone

Address

City

State

Zip

Family Member 1

Phone

Relationship to You

Address

City

State

Zip

Family Member 2

Phone

Relationship to You

Address

City

State

Zip

Family Member 3

Phone

Relationship to You

Address

City

State

Zip

Friend References

Friend 1

Phone

Relationship to You

Address

City

State

Zip

Friend 2

Phone

Relationship to You

Address

City

State

Zip

Friend 3

Phone

Relationship to You

Address

City

State

Zip

Insurance

Name of Insurance Company

*Full coverage, along with comprehensive and collision with deductibles at $500 or less, MUST be kept on the vehicle for the term of the loan.

Vehicle Interest

What vehicle are you interested in?

What are you looking to spend for a down payment?

Submit Application

I give my permission for Gerry’s Used Cars and it’s representatives to get employment and/or landlord verification at any time during our contract period.

Applicant Signature (Initials):

Co-Applicant Signature (Initials):

If you're not a robot, what is 100 + 77?

Credit Application

Applicant Information

Employment and Income

Co-Applicant Information

Co-Applicant Employment and Income

Credit Information

Family References

Friend References

Insurance

Vehicle Interest

Submit Application

Corinna

Veazie

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