ZERR AUTO SALES
751 SOUTH GLENSTONE
417-832-1852
APPLICANT INFORMATION
WHAT VEHICLE ARE YOU INTERESTED IN? ____________________________________
DO YOU HAVE A TRADE IN? IF SO, WHAT? __________________________________________
Year Make Model
HOW DID YOU HEAR ABOUT US? ____________
NAME___________________________________________ ____________________________
First Middle Last Suffix Email
Address
ADDRESS_____________________________________________________________________________
STREET APT#
CITY STATE ZIP 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 TELEPHONE NO#____-____-____ CELL____-____-____
OWN RENT LIVE WITH FAMILY MEMBER (CIRCLE ONE)
LANDLORD INFORMATION_____________________________________________
FIRST LAST PHONE #
IF MARRIED SPOUSES FIRST NAME________________________ SPOUSE’S WORK_______________
NAME ON UTILITY BILL____________________________________
EMPLOYMENT INFORMATION (LAST TWO YEARS)
EMPLOYER NAME_____________________________TELEPHONE#_______________________
ADDRESS_____________________________________TIME ON JOB_______________________
PREVIOUS EMPLOYER_________________________TIME ON JOB_______________________
More on Back
REFERENCE INFORMATION (MUST FILL OUT ALL INFORMATION BELOW)
FAMILY MEMBERS (May
be from Out of State)
#1 NAME______________________________
ADDRESS___________________________________
PHONE#_____-_____-______ RELATIONSHIP_______________
#2 NAME_______________________________
ADDRESS_______________________________
PHONE_____-_____-_______ RELATIONSHIP_______________
FRIENDS/CO-WORKERS/ADDITIONAL FAMILY MEMBERS
#1 NAME________________________________
ADDRESS______________________________
PHONE#_____-_____-______ YEARS KNOWN ______________
#2 NAME________________________________
ADDRESS__________________________________
PHONE#_____-_____-_____ YEARS KNOWN ______________
DO YOU CURRENLY HAVE ANY OUTSTANDING CREDIT DEBTS (mortgages, credit cards, auto loans, personal loans, etc…)? ___________________
IF SO, PLEASE LISTE YOUR CREDITORS AND CURRENT BALANCES
Creditor Payment Current Balance
__________________ ________________ _____________
__________________ ________________ _____________
__________________ ________________ _____________
HAVE YOU TAKEN OUT A LOAN IN THE LAST FIVE YEARS OF THE FOLLOWNG TYPE?
PAYDAY or CHECK CASHING CAR TITLE SIGNATURE or UNSECURED (Circle all that apply)
WHERE?________________________________ WHEN?_________________________________
RELEASE OF INFORMATION TO ZERR AUTO SALES.
(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. Zerr Auto Sales may keep this application whether or not it is approved. By signing below I authorize Zerr Auto to run a credit bureau, run my information through Teletrack, and verify personal and employment references.
____________________________________________ DATE_____-_____-_____
APPLICANT