Dealership Loan Application 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) Live with other(s) — Who? 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 Income Information 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) 1th Reference * 2th Reference * 3th 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. I agree* Submit
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