K&C Auto Sales, Inc.

Applicant Information

Name

Physical Address

City & State

Zip Code

Mailing Address (If different from physical address)

Address: City & State: Zip Code:

Date of Birth

Social Security No.

Driver License No. & State

Phone Number

Cell Number

Monthly Rent or Mortgage

How Long at Current Address

Current Landlord.Mortgage and Phone Number

Do you Rent or Own?

Rent
Own
Live with Parents
Live with Relative

Previous Landlord (If current address is under 3 years)

Previous Address (If current address under 3 years)

Employment Info

Name

Address

Phone Number

Start Date at Job

Hourly Rate

Monthly Salary (Before Taxes)

How Are You Paid?

Weekly
Bi-Weekly
Monthly

Position

Supervisor

Previous Employer (If current job under 2 years)

Address and Phone Number

How long and previous salary

Social Security Benefits (If applicable)

Other Income & Amount (If applicable)

Co Applicant Name (If Applicable)

Address

Zip Code

Date of birth

Social Security No.

Driver License No. & State

Phone Number

Co-Applicant Employment Info

Current Employer

Address

Phone Number

How long on the job

Hourly Rate

Monthly Salary (Before taxes)

How are you paid

Weekly
Bi-Weekly
Monthly

Social Security Benefits (If applicable)

Position

Supervisor

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References (Minimum of 6)

Name, Address, Relationship, & 2 Phone Numbers

Name, Address, Relationship, & 2 Phone Numbers

Name, Address, Relationship, & 2 Phone Numbers

Name, Address, Relationship, & 2 Phone Numbers

Name, Address, Relationship, & 2 Phone Numbers

Name, Address, Relationship, & 2 Phone Numbers

By entering my name below and submitting this form electronically, email, or by fax, I authorize K&C Auto Sales, Inc. to verify the information provided on this form as to my credit and employment history.

Email Address

Co-Applicant Name (If Applicable)

Co-Applicant Email Address

Your Privacy Is Important to Us. Any information you give us will be used to make a credit decision.