Zerr Auto Sales DBA Affordable Equity Finance Co.

751 South Glenstone

Springfield, MO  65802

417-832-1852

 

APPLICANT INFORMATION

 

NAME_____________________________________________________               ________________________

            First                                        Middle                                   Last                        Suffix                      Email Address

 

ADDRESS__________________________________________________               ______________

STREET APT#                     CITY       STATE   ZIP                                                          TIME AT ADDRESS                                                          

PREVIOUS ADDRESS________________________________________               ______________

(If you have lived at your current address for less than two years)                                  TIME AT ADDRESS

 

SOCIAL SECURITY #_____-_____-______     DATE OF BIRTH_____-_____-_____

                            

HOME TELEPHONE NO#____-____-____             CELL____-____-____

 

OWN      RENT     LIVE WITH FAMILY MEMBER (CIRCLE ONE)

 

LANDLORD INFORMATION__________________________________________________________

                                                            FIRST                                     LAST                                     TELEPHONE #                             

 

SIGNIFICANT OTHER’S NAME AND ADDRESS__________________________________________

 

TO WHOM ARE THE UTILITIES BILLED TO? ____________________________________

 

EMPLOYMENT INFORMATION (LAST TWO YEARS)

 

EMPLOYER NAME_____________________________TELEPHONE#_______________________

 

ADDRESS_____________________________________TIME ON JOB_______________________                 

 

PREVIOUS EMPLOYER_________________________TIME ON JOB_______________________

 

JOINT APPLICANT (If Applicable)

THE COSIGNOR IS EQUALLY RESPONSIBLE FOR REPAYMENT OF ANY DEBT INCURRED

 

NAME_________________________________________________________

            First                        Middle                                   Last                                        Suffix

 

ADDRESS_________________________________________________TIME AT ADDRESS_________

 

PREVIOUS ADDRESS_______________________________________TIME AT ADDRESS ________

(If you have lived at your current address for less than two years)

 

SOCIAL SECURITY #______-______-______ DATE OF BIRTH_____-_____-_____

 

HOME PHONE #______-______-______                CELL_____-_____-_____

 

OWN      RENT      LIVE WITH FAMILY MEMBER            (CIRCLE  ONE)

 

LANDLORD INFORMATION___________________________________________________________

                                                                                FIRST                                     LAST                                                     TELEPHONE#

 

EMPLOYMENT INFORMATION (LAST TWO YEARS)

 

EMPLOYER NAME____________________________________TELEPHONE#________________________

 

ADDRESS____________________________________________TIME ON JOB________________________

 

PREVIOUS EMPLOYER ________________________________TIME ON JOB________________________

 

REFERENCE INFORMATION   (MUST FILL OUT ALL INFORMATION BELOW)

THESE PEOPLE MUST KNOW HOW TO GET A HOLD OF YOU AT ALL TIMES!

 

FAMILY MEMBERS (May be from Out of State)

 

#1 NAME______________________________

 

ADDRESS___________________________________

 

PHONE#_____-_____-______ RELATIONSHIP_______________

 

#2 NAME_______________________________

 

ADDRESS_______________________________

 

PHONE_____-_____-_______ RELATIONSHIP_______________                                  

 

FRIENDS/ADDITIONAL FAMILY MEMBERS

 

#1 NAME________________________________

 

ADDRESS______________________________

 

PHONE#_____-_____-______ RELATIONSHIP______________

 

#2 NAME________________________________

 

ADDRESS__________________________________

 

PHONE#_____-_____-_____            _ RELATIONSHIP______________

 

HOW DID YOU HEAR ABOUT AFFORDABLE EQUITY FINANCE CO.?

 

_____Yellow Pages _____Yellow Book  _____Names and Numbers  ____Drive-By  _____TV _____Other

 

Answering the questions below assists us in the underwriting process.  If the answer to any of the questions is yes, you will still be eligible for a loan.

HAVE YOU FILED A CHAPTER 7 OR 13 PERSONAL BANKRUPTCY WITHIN THE LAST SEVEN YEARS?                YES                 NO                  WHEN?___________________

 

DO YOU PAY CHILD SUPPORT?  YES      NO     

IF SO, NAME AND ADDRESS OF THE PERSON WHO COLLECTS THE SUPPORT?

 

________________________________________________________________________

 

HAVE YOU TAKEN OUT A LOAN IN THE LAST FIVE YEARS OF ANY OF THE FOLLOWNG TYPES? 

PAYDAY or CHECK CASHING       YES     OR       NO     

 

CAR TITLE  LOAN                            YES     OR       NO

 

SIGNATURE or UNSECURED          YES     OR       NO

 

PAWN SHOP                                     YES     OR       NO

 

RELEASE OF INFORMATION TO Affordable Equity Finance

(PLEASE READ VERY CARFULLY BEFORE SIGNING)

I certify that everything that I have stated on this application and on any of its attachments are correct.  Affordable Equity Finance Co. may keep this application whether or not it is approved.  By signing below, I authorize Affordable Equity Finance Co. to run a credit bureau, run my information through Teletrack, and verify personal and employment references.

 

____________________________________________           DATE_____-_____-_____

APPLICANT

 

____________________________________________           DATE_____-_____-_____    

JOINT APPLICANT