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Haverhill Motorcars 815 South Main St., Haverhill, MA 01835 Phone (978) 521-7000 Fax (978) 521-8882 |
30
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| Loan Amount $ |
Term
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Automatic Loan Payment | Credit Life & Disability | ||||||
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Year |
Make
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Model | Mileage | Selling Price $ | |||||
| Loan
to be paid off from trade in (name of financial institution) |
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Borrower
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Co-Borrower
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Name
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Name | ||||||||
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Date of Birth ____/____/____ |
Social Security No.
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Date of Birth ____/____/____ |
Social Security No. | ||||||
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Address
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Years There | Address | Years There | ||||||
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City/State Zip
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Phone | City/State Zip | Phone | ||||||
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Previous
Address
|
Years There | Previous
Address (if less than 2 years at current address) |
Years There | ||||||
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Current Employer
|
Years There | Current Employer | Years There | ||||||
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Phone
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Gross Monthly Income | Phone | Gross Monthly Income | ||||||
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Previous
Employer
|
Years There | Previous
Employer (If less than 2 years at current employer) |
Years There | ||||||
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Other Income Source*
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Amount $ | Other Income Source* | Amount $ | ||||||
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Housing
Information (Borrower & Co-Borrower)
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Rent Own Other ______________________
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Rent/Mortgage Payment $_______ per ___ | ||||||||
| I/We certify that all statements made in this application are true to the best of my/our knowledge. I/We authorize you to obtain such information as you may require concerning the statements made in this application and agree that this application shall remain the property of the Lender whether or not the loan is granted. (* You are not required to reveal incoome from child support, alimony or seperate maintenance payments to be considered as a basis for repaying this loan) | |||||||||
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(x) |
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(x) |
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Equal
Opportunity Lender |
Route 125, 815 South Main Street
Haverhill, MA 01835