Personal Information

Sauquoit Automotive Sales and Services Credit Application through Credit Acceptance Corp.
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Personal Information
Full Name*

First NameLast Name
Maiden Name
Primary Number*

Area CodePhone Number
Ext:
Secondary Phone

Area CodePhone Number
Ext:
E-mail*
Date of Birtth (MM/DD/YYYY):*
Social Security Number:*
Residence
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Owned By:*
Monthly Cost:*
Time at this Address:
Years:*
Months:*
Previous Residence:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employment
Primary Income Information: (Alimony, child support, or separate maintenance income need not e revealed if you do not wish to have it considered as a basis for repaying his obligation)
Employment Status:*
Monthly Pay*
Start/Hire Date*

MonthDayYear
Employer/Company Name*
Work Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Ext:
Secondary Income Information: (Alimony, child support, or separate maintenance income need not e revealed if you do not wish to have it considered as a basis for repaying his obligation)
Employment Status:
Monthly Pay
Start/Hire Date

MonthDayYear
Employer/Company Name
Work Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Ext:
**Fixed income applicants are required to submit proof of monthly pay of at least $800.
Vehicle
Vehicle from Inventory:
Other Vehicle:
Your Down Payment (minimum $1000):*
Name of Bank*
Payment choice:*

CheckingSavingsPrepaid Card
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Sauquoit Automotive Sales and Services Credit Application through Credit Acceptance Corp.

Personal Information

Residence

Employment

Vehicle