Hadleys House of Wheels: Pre Approval

Applicants First Name

Middle initial

Last Name

Home Address

City

State

Zip Code

Home Phone

E-Mail Address

Social Security #

Driver's License #

License # State

Exp. Date

Mortgage Company/Lanlord

Status

Own/Buying Renting Other

Name of Nearest Relative not in Household

Relationship

Relative Phone #

Have you ever filed bankruptcy?

yes no

If yes, When?

Employer's Name

Employer's Address

Employer's City

Employer's State

Employer's Zip Code

Current Occupation

Business Phone #

Time on Job

Previous Employer's Name

Previous Employer's Address

Previous Employer's City, State, Zip

Previous Occupation

Previous Business Phone #

Previous Time on Job

Source of other income: alimony, child support or separate maintinance income need not be disclosed if you do not wish to have it considered as a basis for repaying this obligation.

Monthly Income

Additional Monthly Income Source(s)

1. Name of Creditor / Credit Card Co.

Address, Branch, Phone, or Credit Card #

2. Name of Creditor / Credit Card Co.

Address, Branch, Phone, or Credit Card #

3. Name of Creditor / Credit Card Co.

Address, Branch, Phone, or Credit Card #

Previous car financed or Leased with

Bank or Savings & Loan Account

Type of Account

checking savings

Branch or Address

In connection with your transaction , we may obtain nonpublic personal information about you and that information is handled as stated. 1. We collect personal nonpublic information about you from the following sources: A. Information we receive from you on an application for credit or any other similar forms. B. Information about your transaction with us and others. C. Information we receive from a consumer-reporting agency. 2. Please be aware that it our policy to disclose the above nonpublic personal information to only those companies that perform marketing services or other functions on our behalf or to other financial institutions which we have joint marketing agreements. 3. We do not disclose any nonpublic personal information about you to anyone except as permitted by law. 4. further, we restrict access to your nonpublic personal information to only those employees who need to know that information to provide products or service to you. Employees cannot use your information for any other purpose. For your safety, we maintain physical, electronic and procedural safeguards to further guard your nonpublic personal information. By completing this electronic application and pressing the Submit button, I hereby certify that the information provided by me is correct. I also authorize Hadleys House of Wheels to check my credit with credit reporting agencies. Failure to provide all information requested can delay this application.