Saturday, July 31st, 2010 | 10:07 AM

	Primary Applicant Joint Applicant - Application is for joint credit with primary applicant or as a guarantor Joint Applicant - Primary applicant is relying on you for income for alimony, child support, or separate maintenance or on your income or assets as the basis for repayment of the credit requested. If Joint Applicant - Relationship to applicant: S - Married P - Parent O - Other Last Name First Name Middle Name Jr. Sr. Date of Birth (MM/DD/YYYY) / / Social Security Number - - Driver's License No. and State   Physical Address (Number, Street, Apartment City State Zip Code Billing Address (Number, Street, Apartment, PO Box) City State Zip Code County Phone in home? Yes No Phone Number - - Own Rent Live w/Relatives Lived There yrs mos Cell Phone Number - - Other Phone Number - - E-mail Address - Personal E-mail Address - Business Name and Address of Landlord or Mortgage Holder Phone Number of Landlord or Mortgage Holder - - Rent or Mtg. Pmt. $ Previous Address (Street, City, State and Zip Code) (if less than 2 yrs at present address) Lived There yrs Level of Education (Age Under 27 Only) 4yr College Grad 2yr College Grad Special Traning Some College High School Grad? Yes No Current Employer Name Current Employer Address Occupation (If military, state rank) Work Phone Number - - Gross Monthly Salary $ Time on Job yrs mos Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation Source of other income Other Income $ Previous Employer's Name (if less than 5 years at current employer City/State Name of Bank Checking & Savings Savings Only Checking Only No Account Have you ever had a car or other merchandise repossessed? No Yes If Yes, When? Month Year Have you ever filed for bankruptcy No Yes If Yes, When? Month Year Creditor's Name City and State Current/Previous Cars Financed or Leased Through Date Opened Monthly Pmt. Amount Unpaid Balance 1 $ $ 2 $ $ Creditor's Name City and State Other Credit Date Opened Monthly Pmt. Amount Unpaid Balance 3 $ $ 4 $ $ Name and Address of Applicant's Nearest Relatives/Friends Not In Household Phone Number Relationship 1 - - 2 - - 3 - - 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 futher 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. The dealer and its assigns may share and use information about you, including information in this application, with entities that are related by common ownership or affiliated by common control. If you do not want this information shared with these entities please mark the box provided below. By checking this box, I do not want this information shared (other than information on transactions or experiences with me)   I acknowledge by submitting this form that I have read and agree to the terms.

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