Please provide the following personal information:

First name
Last name
Middle initial
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Social Security Number: note:not including your SSI# will prevent processing.

Date of Birth:
Note: not including your date of birth  will prevent processing.

Previous home address if less than two (2) years

Employed By

Occupation

How long have you been there?

Gross salary or wages Per Week Month Year

Other Income? Yes No

Source

Gross monthly amount:

Military status: N/A Active Duty Reserve

Has any of your property ever been repossessed?
Yes No

Have you been personally involved in a bankruptcy proceeding in the last 10 years?
Yes No

Are you a endorser or guarantor on any other loan or contract?
Yes No

Are there unsatisfied judgments (suits pending) against you?
Yes No

Last vehicle financed

Name of Creditor

Balance due or date paid

Trading in this car?
Yes No

Drivers License #

State

Insurance Company

Policy number and exp. date:

Coverage
Deo. Coll
Liability
Comp.
Other

FAIR CREDIT REPORTING ACT NOTICE TO CONSUMER

THIS WILL ADVISE YOU THAT YOUR RETAIL INSTALLMENT SALES CONTRACT AND BUYERS APPLICATION WILL BE SUBMITTED TO MULTIPLE LENDING INSTITUTIONS FOR PURCHASE AND CONSIDERATION AS TO WHETHER YOU MEET THEIR CREDIT REQUIREMENTS.

I UNDERSTAND THE ABOVE SAID DISCLOSURE.

AND I GIVE SEA BREEZE FORD  AND ANY OTHER FINANCIAL INSTITUTION WHICH MAY REVIEW THIS CREDIT APPLICATION PERMISSION TO INVESTIGATE MY CREDIT AND EMPLOYMENT HISTORY , AND TO ANSWER QUESTIONS ABOUT MY CREDIT EXPERIENCE WITH ME. I FURTHER AUTHORIZE ANY AND ALL FINANCIAL INSTITUTIONS USED TO FIND ME FINANCING TO CONDUCT A CREDIT INVESTIGATION BASED ON THE INFORMATION VOLUNTARILY PROVIDED BY ME IN THIS APPLICATION.