Zerr Auto Sales

751 South Glenstone

Springfield, MO 65802

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________________________

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_____-_____-_____

JOINT APPLICANT