Dealership Loan Application Application Information: Dealership Information Dealership Name Dealership Email Dealership Phone Customer Details First Name Last Name DOB Social Security Phone (Cell) Email Address Arizona How long at your current address? Less than 6 months 1 year 2 years 3+ years Own or Rent? Own Rent Live with other(s) Who do you live with? Monthly Payment Employment History Employer Job Title Phone How long at primary job? Less than 6 months 1 year 2 years 3 years 4 years 5+ years Arizona Next Pay Date Pay Schedule Daily/Weekly Bi-Weekly Twice a Month Monthly Direct Deposit? Yes No Bank Name Type Checking Account Debit Card Pre-Paid Debit Reference (not living with you — relatives preferred) 1st Reference 2nd Reference 3rd Reference 4th Reference By Submitting this Application you agree to the following: If we are unable to reach you, you authorize us to contact the references you have provided to obtain updated contact information for you. I give the information on this application for the purpose of obtaining credit and certify that all information contained herein is complete and accurate. I authorize Cash Time Loan Centers to obtain a credit report, income, residence, credit history, personal references, and verification of employment. Submit