Phone: 626-320-5008
Fax: 562-695-6665
11201 Washington blvd
Whittier ca 90606
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Secure Loan Application
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Desired Loan Amount
*
Desired Monthly Payment
First Name
*
Middle Initial
Last Name
*
Address
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City
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State
*
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California
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Zip
*
Daytime Phone
*
Evening Phone
Fax
Email
*
Social Security Number
Birthday
*
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Mortgage/Rent Payment
*
per month
Residence Type
*
Own Home with Mortgage
Own Home without Mortgage
Rent
Live with Relative
Other
Time at Residence
*
Years
Time at Residence
*
Months
If you have lived at your current residence less than 5 years, please enter your prior address:
Which accounts are in your name
Utilities
Savings
Checking
Phone
Drivers Lic. #
Drivers Lic. State
(CA,NY, etc.)
Driver Lic. Exp. Date
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Employer Name
*
Employer Address
*
Employer City
*
Employer State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Employer Zip
*
Business Phone
*
Occupation
*
Time On Job
*
Years
Time On Job
*
Months
Salary
*
per month
Other Income
*
per month
Consent
I consent that by submitting this application, I am authorizing this dealership to check my credit.
Vehicle Make
Vehicle Model
Vehicle Year
Vehicle Mileage
Down Payment Amount
Trade-in Make
Trade-in Model
Trade-in Year
Trade-in Mileage
Additional Comments
Security Code:
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