Full Credit Application - Dixie Auto Loans

Credit Application

Please fill out the information below and one of our representatives will contact you regarding your credit application request.

Customer Information

First Name ^*

Last Name ^*

Date Of Birth ^*

Email Address

Phone ^{* Enter only the 3 digit area code, Number "1" is not required.}

Cell Phone ^{* Enter only the 3 digit area code, Number "1" is not required.}

Work Phone

Source

Whom have you been communicating with at our dealership? (if anyone)

Credit Application - Current Address Information

Current Address

Address Type ^*

Street #/Name ^*

Street Suffix ^*

City ^*

Province ^*

Postal Code ^*

Apt #

Address Duration ^* Years Months

Credit Application - Previous Address Information

Previous Address

Address Type ^*

Street #/Name ^*

Street Suffix ^*

City ^*

Province ^*

Postal Code ^*

Apt #

Home Status

Address Duration ^* Years Months

Credit Application - Current Employment Information

Current Employment

Employement Type ^*

Employement Status ^*

Employer ^*

Occupation ^*

Employment Duration ^* Years Months

Gross Monthly Income ^*

Source of other Income

Other Income

Have You Ever Declared Bankruptcy? No Yes

Is a Cosigner available if needed? No Yes

Credit Application - Assets and Liabilities

Current Address

Home Status ^*

Assets and Liabilities

Rent Payment

Balance of Mortgage

Value of House

Monthly Payment

Disclaimer: By submitting this application, you authorize us to run your credit report.

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