ZERR AUTO SALES

751 SOUTH GLENSTONE

SPRINGFIELD, MO  65802

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_______________________

 

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JOINT APPLICANT (If Applicable)

 

NAME___________________________________________________

 

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#

 

NAME ON UTILITY BILL___________________________

 

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)

                                           2 FAMILY MEMBERS WITH A PHONE THAT IS WORKING!

                                           2 FRIENDS THAT YOU KNOW VERY WELL!

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/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                                   Current Balance

 

__________________            ____________________________

 

__________________            ____________________________

 

__________________            ____________________________

 

__________________            ____________________________

 

__________________            ____________________________

 

__________________            ____________________________

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HAVE YOU FILED A CHAPTER 7 OR 13 PERSONAL BANKRUPTCY WITHIN THE LAST SEVEN YEARS?                            YES       NO                HOW LONG AGO___________________

 

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

 

____________________________________________           DATE_____-_____-_____    

JOINT APPLICANT