Credit Application

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* Required Field

Application Type *

Personal Information

Applicant:

First Name *

Middle Name/Initial

Last Name *

Email Address *

Home Phone

Work Phone

Cell Phone *

Social Security #*

Date of Birth *

Driver's License # *

Driver's License Exp. Date *

Driver's License Issued In

Marital Status

How should we contact you? *

When should we contact you?

Co-Applicant

First Name *

Middle Name/Initial

Last Name *

Email Address *

Home Phone

Work Phone

Cell Phone *

Social Security # *

Date of Birth *

Driver's License # *

Driver's License Exp. Date *

Driver's License Issued In

Marital Status

Employment Information

Applicant:

Employment Status *

Current Employer *

Title / Occupation *

Employer Address *

Employer Address Line 2

City *

State*

Zip Code *

Business Phone *

Time at Employer - Years *

Time at Employer - Months *

Gross Monthly Income *

Co-Applicant

Employment Status

Current Employer *

Title / Occupation *

Employer Address *

Employer Address Line 2

City *

State*

Zip Code *

Business Phone *

Time at Employer - Years *

Time at Employer - Months *

Gross Monthly Income *

Residential Information

Applicant:

Current Address *

Current Address Line 2

City *

State*

Zip Code *

Status *

Mortgage Payment / Rent *

Time at Residence - Years *

Time at Residence - Months *

Previous Address

Previous Address Line 2

City

State

Zip Code

Status

Mortgage Payment / Rent

Time at Residence - Years

Time at Residence - Months

Co-Applicant

Current Address *

Current Address Line 2

City *

State*

Zip Code *

Status *

Mortgage Payment / Rent *

Time at Residence - Years *

Time at Residence - Months *

Previous Address

Previous Address Line 2

City

State

Zip Code

Status

Mortgage Payment / Rent

Time at Residence - Years

Time at Residence - Months

Trade-In Vehicle

VIN

Year

Make

Model

Exterior Color

Mileage

Condition

Asking Price

Remaining Balance

Describe Vehicle Condition and History

I certify that the information provided by me is correct.
I certify that I am eighteen years of age or older.

I also understand that you will be checking with credit reporting agencies.
I authorize an investigation of my credit and employment history and the release of information about my credit experience.

Dealership Info

Contact Us

Main Phone:

503-880-7066

Alt. Phone:

360-608-1677

Fax:

503-477-9092

Email:

yourdealerdan@gmail.com

Business Hours

Mon:	APPOINTMENT ONLY
Tue:	APPOINTMENT ONLY
Wed:	APPOINTMENT ONLY
Thu:	APPOINTMENT ONLY
Fri:	APPOINTMENT ONLY
Sat:	APPOINTMENT ONLY
Sun:	CLOSED

Location

9400 Ne Halsey St
Portland, OR 97220