Auto Mart Of Salem
 Online Credit Application

INSTRUCTIONS: Fill out this application form completely and accurately. All statements in your application are subject to verification. Failure to provide all information requested can delay this application. Approval based on lender criteria. Please fill out the Primary Applicant information. The Co-Applicant information is optional.
Primary Applicant

Name:   Last:    First:    Middle:

Current Address:    Street & Apt#:   City:   State:   Zip Code:

Cell Phone:   Work Phone:   Home Phone:

Social Security #:   Date of Birth (07/04/70):

Email Address:

Driver's License #:   State Issued:   Issuing Date:   Expiration Date:

Do you rent or own?:   Mthly rent/mtg: $

How long at this residence?    How long at prev. residence?

Current Employer:  Occupation:  How Long?

Previous Employer:  Occupation:  How Long?

Gross Monthly Income: $  Bank acct?

Other Income (disability, child support):    Source:

Have you ever filed for bankruptcy? Have you ever had a car or other merchandise repossessed?

Statement of Consent
 I certify that the information provided by me is correct. 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. I have read and received a copy of your Privacy Notice and agree to all of the above.
(Initial here) 


Co-Applicant (optional)

Name:   Last:    First:    Middle:

Current Address:  Street & Apt#:   City:   State:   Zip Code:

Cell Phone:   Work Phone:   Home Phone:

Social Security #:   Date of Birth (07/04/70):

Email Address:

Driver's License #:   State Issued:   Issuing Date:   Expiration Date:

Do you rent or own?:   Mthly rent/mtg: $

How long at this residence?    How long at prev. residence?

Current Employer:  Occupation:  How Long?

Previous Employer:  Occupation:  How Long?

Gross Monthly Income: $  Bank acct?

Other Income (disability, child support):    Source:

Have you ever filed for bankruptcy?

Have you ever had a car or other merchandise repossessed?

Statement of Consent
I certify that the information provided by me is correct. 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. I have read and received a copy of your Privacy Notice and agree to all of the above.
(Initial here) 



Non-Affiliated Third Party Sharing

  IF THE BOX AT LEFT IS CHECKED, then we reserve the right to disclose nonpublic personal information to third parties, such as market research firms, direct marketing companies, finance service providers and others who may from time to time seek to provide you information on valuable products or services. YOU MAY OPT OUT of this sharing by checking the box below.

  I DIRECT YOU NOT TO SHARE nonpublic personal information about me to non-affiliated third parties, except as provided in this Privacy Policy.


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