Submitting this credit application information gives Randy Blount Automotive Group finance department permission from the sender to run a credit check, with the understanding that the information on the credit report will not be sold or distributed to other companies or persons as protected under the Fair Reporting Act. Only recognized lending institutions will be privileged to the credit information in order to secure a vehicle loan.
WHEN YOU SEE THIS SYMBOL CLICK FOR MORE INFORMATION.
LAST NAME
FIRST NAME
MIDDLE NAME
CHECK ONE
JR. SR.
DATE OF BIRTH
(EX: 02/12/1940)
SOCIAL SECURITY NO.
CURRENT DRIVERS
LICENSE
YES: NO: STATE:
ADDRESS (STREET, NUMBER, APT NO)
CITY
STATE
ZIP CODE
BILLING ADDRESS
CITY
STATE
ZIP CODE
IN HOME PHONE
PHONE NO /AREA CODE
CELL PHONE NO.
E-MAIL ADDRESS
PERSONAL
YES: NO:
E-MAIL ADDRESS
BUSINESS
OWN
HOME
BUYING HOME
LEASING/
RENTING
LIVING WITH
RELATIVES
LIVED THERE
FOR:
YES:
NO:

YES:
NO:

YES:
NO:
YES:
NO:
YEARS:
MONTHS:
NAME & ADDRESS OF
LANDLORD
OR MORTAGE HOLDER
PHONE NO OF LANDLORD
OR MORTAGE HOLDER
MONTHLY RENT OR
MORTAGE PAYMENT
$
PREVIOUS ADDRESS
LIVED THERE
YEARS: APPROX.
 
LEVEL OF EDUCATION
(AGE UNDER 27 ONLY)
4-YEAR COLLEGE GRAD.:
2-YEAR COLLEGE GRAD.:
SOME COLLEGE:
TRADE SCHOOL:
HIGH SCHOOL GRAD:
YES: NO:
CURRENT EMPLOYER NAME
EMPLOYER ADDRESS
EMPLOYER PHONE
YOUR JOB TITLE
(IF MILITARY STATE RANK)
GROSS MONTHLY SALARY
TIME ON CURRENT JOB
$
YEARS:
MONTHS:
SOURCE OF OTHER INCOME
AMT OF OTHER INCOME
CHILD SUPPORT?
$
$ IS IT COURT ORDERED?
YES: NO:
PREVIOUS EMPLOYER'S NAME
CITY
STATE
NAME OF BANK
TYPE OF ACCOUNTS
SAVINGS ONLY:
CHECKING & SAVINGS:
CHECKING ONLY:
NO ACCOUNT:
EVER HAD A
CAR REPOSSESSED?
IF YES, WHEN?
EVER FILED
BANKRUPTCY?
IF YES, WHEN?
IF YES, WAS IT A
YES:
NO:
MONTH:
YEAR:
YES:
NO:
MONTH:
YEAR:
CHAPTER 7:
CHAPTER 13:
CREDIT HISTORY
DATE
OPENED

MONTHLY
AMOUNT

APPROX.
BALANCE
OTHER CREDIT
DATE
OPENED
MONTHLY
AMOUNT
APPROX
BALANCE
PERSONAL REFERENCES
(SHOW COMPLETE ADDRESS WITH ZIP)
TELEPHONE/
AREA CODE
RELATIONSHIP
FRIEND/RELATIVE
 
COMMENTS OR QUESTIONS
  
FOR THE PURPOSE OF SECURING CREDIT FROM YOU, I CERTIFY THAT THE ABOVE INFORMATION IS TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. APPLICANT FURTHER CERTIFIES THAT I HAVE ATTAINED THE AGE OF MAJORITY. APPLICANT AUTHORIZED YOU TO CHECK MY CREDIT AND EMPLOYMENT HISTORY AND TO PROVIDE AND/OR OBTAIN INFORMATION ABOUT CREDIT EXPERIENCE WITH ME.
SIGNATURE (TYPE FULL NAME) DATE