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One Buyer - More than one Buyer

Name:   DOB:
SS#: Email Address:
Home Phone: Cell: Time in Area:
Home / Cell Phone Listed to:   Marital Status:
DL#: State: Exp. Date. Down Payment:

Current Employer
Previous Employer
Previous Employer
Employer: Employer: Employer:
Address: Address: Address:
City, State: City, State: City, State:
Phone: Phone: Phone:
Position: Position: Position:
Shift Shift Shift
How Long Employed: How Long Employed: How Long Employed:
Hourly Rate: Hourly Rate: Hourly Rate:
Supervisor: Supervisor: Supervisor:
Pay Frequency: Pay Frequency: Pay Frequency:
Monthly Income (after taxes): $   Monthly Income (after taxes): $   Monthly Income (after taxes): $  

Other Income*
Source: Source: Source:
Frequency: Frequency: Frequency:
Monthly Income (after taxes): $ Monthly Income (after taxes): $ Monthly Income (after taxes): $
* Alimony, child support, or separate maintenance income need not by revealed if you do not wish it considered as a basis for repayment.

I request credit from Dealer in the amount and under the terms for which I qualify. I hereby certify that, unless stated above, I am not currently in any bankruptcy proceedings or legal proceedings that would adversely affect my ability to repay the credit requested, and that the information I have provided in this application is complete and accurate. Dealer may submit my application to Leighton Associates, Inc., d.b.a. Cheyenne Auto Credit P.O. BOX 15656, Cheyenne, Wyoming 82003, for consideration and to other potential creditors. Dealer and CAC may investigate my credit and employment history, obtain information about me from persons identified with my application (references, employers, creditors and landlords), and obtain consumer reports about me from credit reporting agencies.

Date:

       

 
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