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Secure Credit Application

Fields in blue are required

Credit Application Type
Loan Information
Loan amount requested
Desired # of monthly payments
Desired monthly payment
Amount Down
Applicant's Personal Information
Full Name
   
Marital Status
Social Security #
- -
Driver's License #
Driver's License Exp Date
Date of Birth
Email Address
Home Phone
Cell Phone
Applicant's Current Address
Street 1
Street 2
City / State / Zip
Date you started living here
Have you lived here more than 5 years?
Have you lived here more than 5 years?
   
Applicant's Financial Information
Current Bank
Previous Bankruptcy?
Previous Bankruptcy?       
Pending Bankruptcy?
Pending Bankruptcy?       
Applicant's Current Employer
Employer Name
Job Title
Phone Number
Date you began working there
Gross monthly income
Applicant's Previous Employer
Employer Name
Job Title
Phone Number
Date you began working there
Applicant's Additional Income
Additional Monthly Income
Co-Applicant's Personal Information
Full Name
   
Relationship to Applicant
Social Security #
- -
Driver's License #
Driver's License Exp Date
Date of Birth
Email Address
Home Phone
Cell Phone
Co-Applicant's Current Address
Street 1
Street 2
City / State / Zip
Date you started living here
Have you lived here more than 5 years?
Have you lived here more than 5 years?
yes     no
Co-Applicant's Financial Information
Current Bank
Previous Bankruptcy?
Previous Bankruptcy?       
Pending Bankruptcy?
Pending Bankruptcy?       
Co-Applicant's Current Employer
Employer Name
Job Title
Phone Number
Date you began working there
Gross monthly income
Co-Applicant's Previous Employer
Employer Name
Job Title
Phone Number
Date you began working there
Co-Applicant's Additional Income
Additional Monthly Income
Financial Debts / Obligations
Type of Debt
Holder
Balance
Payment (mo/wk/etc)
Personal References
Relationship
Name
Phone
Address (City/State)

to authorize us to share your nonpublic personal information with affiliated and/or nonaffiliated third parties. I understand that in checking this that you may be better able to serve me and that I may receive offers for other products and services that may be of value to me. Please read our privacy policy for more information regarding your rights and how we use the personal information you submit to us.

FAIR CREDIT REPORTING ACT DISCLOSURE:

This application for credit may be submitted by the Dealer to various financial institutions. Before this application is submitted, the Dealer will disclose to you the name and address of the institution(s) who will receive copies of this application.

By clicking on the 'submit' button below I certify that the above entered information to be true and correct and I hereby authorize you to use this information to perform a credit rating check of my personal credit. I also certify that I am over the age of 18 and am a current U.S. citizen or permanent resident. In addition, I understand that submitting the above information does not represent an obligation by any party to provide credit nor does it obligate me to accept any credit offered.

Blue Moon Auto Sales
3511 North Highland Ave
Jackson, TN 38305
(731) 410-8200
HOURS
Monday Closed
Tuesday 9:00AM - 6:00PM
Wednesday 9:00AM - 6:00PM
Thursday 9:00AM - 6:00PM
Friday 9:00AM - 6:00PM
Saturday 9:00AM - 5:00PM
Sunday Closed