FINANCE DEPARTMENT

(888) 666-6343

Online Credit Application

Applicant Information

Last Name:     First Name:     MI:     Suffix: - JR SR I II III IV V

Date of Birth (MM/DD/YYYY): //    Social Security Number:

Phone No:     Cell Phone:     Email:

Mailing Address:     City:     State:     Zip Code:

Physical Address (If different from mailing address):     City:     State:     Zip Code:

Time at Address: Yrs.   Mon.    Resident Type: - Own Buying Renting Live with Relatives     Rent/Mortgage:

Employment Status: - Full Time Part Time Temporary Retired Not Applicable     Employment Title:     Employer:

Business Phone No:     Time at Job/Time Retired: Yrs.   Mon.

Gross Income:     Income Interval: - Weekly Bi-Weekly Semi-Monthly Monthly Yearly

Other Income Source:     Other Income Amount:     Other Income Interval: - Weekly Bi-Weekly Semi-Monthly Monthly Yearly

Co-Applicant Information

(Only complete this section if you have a a co-applicant)

Relationship to Applicant:

Last Name:     First Name:     MI:     Suffix: - JR SR I II III IV V

Date of Birth (MM/DD/YYYY): //    Social Security Number:

Phone No:     Cell Phone:     Email:

Mailing Address:     City:     State:     Zip Code:

Physical Address (If different from mailing address):     City:     State:     Zip Code:

Time at Address: Yrs.   Mon.    Resident Type: - Own Buying Renting Live with Relatives     Rent/Mortgage:

Employment Status: - Full Time Part Time Temporary Retired Not Applicable     Employment Title:     Employer:

Business Phone No:     Time at Job/Time Retired: Yrs.   Mon.

Gross Income:     Income Interval: - Weekly Bi-Weekly Semi-Monthly Monthly Yearly

Other Income Source:     Other Income Amount:     Other Income Interval: - Weekly Bi-Weekly Semi-Monthly Monthly Yearly

Sale Vehicle

(Only complete this section if you are applying for a specific vehicle)

Stock No:     VIN:     Year:     Make:     Model:

Trade Vehicle

(Only complete this section if you have a vehicle to trade)

VIN:     Year:     Make:     Model:     Mileage:

Overall Condition of Vehicle: - Excellent Good Fair Poor     Title Type: - New Used Salvage Rebuilt     Lienholder:     Payoff Amount:

Contract Information

(This section is optional)

Amount you want to finance:     Down Payment:     Term: - 24 Months 36 Months 48 Months 60 Months 72 Months 84 Months     Preferred Payment Amount:

Application Disclosure

By electronically submitting this application:

I authorize Percy's Auto Sales (Dealer) and any finance company, bank or other financial institution to which the Dealer submits my application ("you") to investigate my credit and employment history, obtain credit reports, and release information about your credit experience with me as the law permits.

If an account is created, I authorize you to obtain credit reports for the purpose of reviewing or taking collection action on the account, or other legitimate purposes associated with the account.

FAIR CREDIT REPORTING ACT DISCLOSURE: I/We understand that this application for credit will be submitted by the dealer to various financial institutions for evaluation.

I certify that I have read and agree to the terms of this application and that the information in it is complete and true.

I certify that I have reviewed and agree to Percy's Auto Sales Privacy Notice.                         

If you submit this application electronically, you intend that process to be your electronic signature on an electronic application, acknowledge receipt of all disclosures provided on the credit application, and give your authorization and consent to Percy's Auto Sales, Inc. to take the actions identified in the credit application.