HARTLEY's
LOAN INFORMATION

Application: Individual  Joint

I am interested in a: New Vehicle  Used Vehicle

Potential monthly payment:

Are you able to make a downpayment: Yes  No

If so, enter amount of down payment: (If not, enter "0")


PERSONAL INFORMATION

Name:

Date of Birth: (EX: MM/DD/YY)

Social Security #: (EX: 123-45-6789)

Email Address:

CURRENT RESIDENCE:
Street Address:

City:    State:    Zip Code:

Home/Primary Phone Number:

Length of time in residence: Years: Months:

Residence Status: Own  Rent  Other

Residence Payment:

PREVIOUS RESIDENCE:
(If current residence is inhabited less than 3 years.)

Street Address:

City:    State:    Zip Code:

Home/Primary Phone Number:

Length of time in residence: Years: Months:

Residence Status: Own  Rent  Other

Residence Payment:

EMPLOYMENT INFORMATION:
Employed By:

Title/Position:

Gross Monthly Income:

Business Phone:

Length of employment: Years: Months:

Other Gross Income:

PREVIOUS EMPLOYMENT INFORMATION:
(If employeed in current position for less than 3 years.)
Employed By:

Title/Position:

Gross Monthly Income:

Business Phone:

Length of employment: Years: Months:

Other Gross Income:

NOTE: Income from alimony, child support, or seperate maintenance payments need not be revealed if the applicant does not choose to have it considered as the basis for repaying the loan.


CO-APPLICANT INFORMATION

Name:

Date of Birth: (EX: MM/DD/YY)

Social Security #: (EX: 123-45-6789)

CURRENT RESIDENCE:
Street Address:

City:    State:    Zip Code:

Home/Primary Phone Number:

Length of time in residence: Years: Months:

PREVIOUS RESIDENCE:
(If current residence is inhabited less than 3 years.)
Street Address:

City:    State:    Zip Code:

Home/Primary Phone Number:

Length of time in residence: Years: Months:

EMPLOYMENT INFORMATION:
Employed By:

Title/Position:

Gross Monthly Income:

Business Phone:

Length of employment: Years: Months:

Other Gross Income:

PREVIOUS EMPLOYMENT INFORMATION:
(If employeed in current position for less than 3 years.)
Employed By:

Title/Position:

Gross Monthly Income:

Business Phone:

Length of employment: Years: Months:

Other Gross Income:

NOTE: Income from alimony, child support, or seperate maintenance payments need not be revealed if the applicant does not choose to have it considered as the basis for repaying the loan.

SUBMIT CREDIT APPLICATION
I agree that all the information in this SCHEDULE SERVICE is complete and true, whether completed by me/us or by you at my/our direction.  During the review of my/our SCHEDULE SERVICE, you may obtain my/our credit history, and employment history, and if the application is approved, you may at any time obtain additional credit histories to review my/our account.  I/We have the right to ask you for the name and address of the credit bureau which gave the credit history.  I/We also give any other source permission to obtain credit information about me/us.
Schedule a Test Drive CREDIT APPLICATION  SCHEDULE SERVICE 
hartley's auto mall
30 main st   p.o. box 38   newport, me 04953   ph: 207.368.5751   fax: 207.368.5456
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