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Online Credit Application Information


COLVIN AUTO SALES & SERVICE

260 Skyland Boulevard East
Tuscaloosa, Alabama, 35405
Phone: (205) 391-9411
Fax: (205) 391-0731
Full Name: Email: SSN: - Last 4
Age: Date Of Birth:
Driver License No. & State:
Present Address: Main Phone Number: A value is required.
City: State: Zip Code:
About Your Home: Buy Own Rent Other
Monthly Payment:
How Many Years: How Many Months:
Previous Address:    
City: State: Zip:

 
Present Employer: Position:
Employer's Address: Phone No:
Employer's City: State: Zip:
Length Of Employment:
Months:
Salary Bring Home:
Salary / Wage:
Daily Weekly Bi-Weekly Monthly Annually


     
Previous Employer: Position:
Previous Employer City: State: Zip:
Previous Employer Salary Bring Home:
Previous Employer Salry / Wage:
Daily Weekly Bi-Weekly Monthly Annually
Length Of Employment: Months:
Other Monthly Income: Income Source:
Name Of Nearest Realative: Relationship:
Realative's Address: Phone No:
City: State: Zip Code:
ADDITIONAL AUTHORIZATION INFORMATION SECTION
 

Intials

The undersigned hereby authorizes selling dealer to initiate a credit invesitgation based upon the following information, which information has been voluntarily provided by myself and warrants the truth and accuracy of this information. The undersigned further warrants that a bankruptcy proceeds is neither presently in progress nor anticipated and acknowledges receipt of this credit application.


Intials

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on the basis of race, color, religion, national origin, sex, marital status, age (provided that the applicant has the capacity to contract); because all or part of the applicant income derives from any public assistance program; or because the applicant has in good faith exercised any right under the Consumer Credit Protection Act. The Federal agency that administers compliance with this law concerning this creditor is the Federal Trade Commission, Equal Credit Opportunity, Washington, D.C. 20580.

 

By signing below, you hereby acknowledge that all of the information contained herein is true and correct. You further acknowledge that selling dealer (and assignees of selling dealer who may hereafter purchase the dealer’s interest in any financing agreement between you and selling dealer) are relying upon the information contained herein in determining whether to extend credit to you. Finally, you acknowledge and agree that providing false information on this application will represent a default of any financing agreement entered into between you and selling dealer in connections with this application.

Digital Signature

 

Print Signature Name: Date Signed:
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