Applicant
Information
Personal
Information:
First
Name:
*
Last
Name:
*
Birth
Date:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
January
February
March
April
May
June
July
August
September
October
November
December
/
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
* Social
Security #:
*
Home
Phone:
*
Email
Address:
*
Present
Address:
Address
(no p.o. box):
*
City,
State, Zip:
*
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MO
MS
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
DC
WV
WI
WY
*
Resident
Time:
Years
Months*
Resident
Type:
Rent
Own Home
Own Mobile Home
Live With Family
Military
*
Monthly Rent / Mrg Payment::
*
Previous
Address If Less Than Two (2) Years At Present Address:
Address:
City,
State, Zip:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MO
MS
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
DC
WV
WI
WY
Resident
Time :
Years
Months
Employer
Information:
Employer:
*
City,
Sate,. Zip:
*
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MO
MS
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
DC
WV
WI
WY
*
Phone:
*
Time
Employed:
Years .
Months .*
Occupation:
*
Monthly
Wage:
* (Gross, Before Tax)
Other
income:
(source)
Other
Income Amount:
(dollar amount of other income)
Previous
Employer If Less Than Two (2) Years At Current Job:
Employer
:
City,
State Zip:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MO
MS
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
DC
WV
WI
WY
Phone:
Time
Employed:
Years
Months
Type
Of Vehicle You Want:
Make:
*
Model:
*
Year:
*
Down
Payment:
*
Trade
Vehicle:
Make:
Model:
Year:
Owed On Trade :
Monthly Payment:
Trade Financed With :
(bank name)
Had
Vehicle Repossessed?
Had House Foreclosed?:
Filed
Bankruptcy?:
Yes
No If
Yes, Year Filed?
(Optional), Please include
any additional information
or comments you feel
would be helpful to
provide us with:
Co-Applicant
Information *
Information below is only required for a Co-Applicant
Co-Applicant Relationship:
Relationship
to Applicant:
Spouse
Mother
Father
Mother-in-law
Father-in-law
Family-Member
*
Personal
Information:
First
Name:
*
Last
Name:
*
Birth
Date:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
January
February
March
April
May
June
July
August
September
October
November
December
/
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
* Social
Security #:
*
Home
Phone:
*
Email
Address:
Present
Address:
Address:
*
City,
State Zip:
*
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MO
MS
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
DC
WV
WI
WY
*
Resident
Time:
Years
Months *
Rent/Mrg
Payment:
*
Previous
Address If Less Than Two (2) Years At Present Address:
Address:
City,
State Zip:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MO
MS
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
DC
WV
WI
WY
Resident
Time:
Years
Months
Employer
Information:
Employer:
*
City,
State, Zip:
*
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MO
MS
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
DC
WV
WI
WY
*
Phone:
*
Employed:
Years
Months *
Occupation:
*
Monthly
Wage:
* (Gross, Before Tax)
Other
income:
(source)
Other
Income Amount:
(dollar amount of other income)
Previous
Employer If Less Than Two (2) Years At Current Job:
Employer:
City,
State, Zip:
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MO
MS
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
DC
WV
WI
WY
Phone:
Employed:
Years
Months
Had
Vehicle Repossessed?
Had House Foreclosed?:
Filed
Bankruptcy?:
Yes
No If
Yes, Year Filed?
Submission
Information, Please Read:
By submitting this application to Yuma Auto and RV Sales Center via (yumaautocenter.com) I certify that I am over 18 years of age. I authorize Yuma Auto and RV Sales Center or any of your Banks, Lenders, or affiliates to check my credit and verify any information on this application. The Co-Applicant, if any, has knowledge and has given their consent to this application. I/we warrant that all information submitted is true and correct.
I understand that falsifying information for credit is a federal offense and a felony.
For Security,
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