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Brick City Motors Credit Application

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* Required Field

Application Type *

Personal Information

Applicant:

First Name *

Middle Name/Initial

Last Name *

Email Address *

Home Phone *

Work Phone *

Cell Phone

Social Security #*

Date of Birth *

Driver's License #

Driver's License Exp. Date

Driver's License Issued In

Co-Applicant

First Name *

Middle Initial

Last Name *

Email Address *

Home Phone *

Work Phone *

Cell Phone

Social Security # *

Date of Birth *

Driver's License #

Driver's License Exp. Date

Driver's License Issued In

Employment Information

Applicant:

Employment Status *

Current Employer *

Title / Occupation *

Employer Address *

Employer Address Line 2

City *

State*

Zip Code *

Business Phone *

Time at Employer - Years *

Time at Employer - Months *

Gross Monthly Income *

Co-Applicant

Employment Status

Current Employer *

Title / Occupation *

Employer Address *

Employer Address Line 2

City *

State*

Zip Code *

Business Phone *

Time at Employer - Years *

Time at Employer - Months *

Gross Monthly Income *

Residential Information

Applicant:

Current Address *

Current Address Line 2

City *

County *

State*

Zip Code *

Status *

Mortgage Payment / Rent *

Time at Residence - Years *

Time at Residence - Months *

Co-Applicant

Current Address *

Current Address Line 2

City *

County *

State*

Zip Code *

Status *

Mortgage Payment / Rent *

Time at Residence - Years *

Time at Residence - Months *

Financial Information

Applicant:

Mortgage Balance

Mortgage Lender

Monthly Payment

Name of Bank

Account Type(s)

Name of Bank

Account Type(s)

Other Income (monthly)

Source

Other Income (monthly)

Source

Other Income (monthly)

Source

Desired Vehicle

Filter Desired Vehicle

Year:

Make:

Model:

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Desired Vehicle

Desired Loan

Vehicle Price

Down Payment *

Trade-In Value

Sales Tax

Interest Rate

Loan Term (Months)

Amount Financed

Monthly Payment

I certify that the information provided by me is correct.
I certify that I am eighteen years of age or older.

I also understand that you will be checking with credit reporting agencies.
I authorize an investigation of my credit and employment history and the release of information about my credit experience.