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Credit Application

To speed processing, please fill out application as completely as possible.  Items in marked with a RED * are REQUIRED.

Vehicle applying for (if known) Price Down Payment

Have you purchased a vehicle from E. Curtis Auto Sales before? 
Yes  No

If Yes, were you the buyer or co-buyer? 
Buyer  Co-Buyer   Did you pay the vehicle off?  Yes  No

If No, please explain


Are you buying a vehicle for you to drive or for someone else? 
For Me  For Someone Else

If for someone else, what is you relationship to them? (friend, boyfriend, cousin, etc.) 



* First Name Middle Initial * Last Name

*Social Security #        *Birth Date        Age  

Marital Status 
Married  Single  Divorced

* Address
  * City   * State   * Zip

Home Phone #
   Cell Phone / Pager  

Email Address



* Rent  Own   Landlord or Apartments Name

* Landlord or Apartments Phone #
   * How long have you lived there?  Years   Months

List Utilities in Your Name



* Employer
  * How long?  Years   Months

How are you paid? 
Weekly    Bi-Weekly    Monthly    Semi-Monthly    Daily

* Employer Address


* Employer Phone #
  Occupation

Direct Work Phone # or Extension


Work Address, if different from above



Co-Buyer's Name


Co-Buyer's Address


Co-Buyer's Phone #
  Co-Buyer's Employer

Co-Buyer's Employer Address


Co-Buyer's Employer Phone #
  How Long?  Years   Months


Supplemental Income (child support, tips, etc.)


Have you ever had merchandise repossessed? 
Yes   No

If Yes, explain


Have you declared Bankruptcy in the past ten years? 
Yes   No

If Yes, give date filed
   Type  Chapter 7   Chapter 13

Has your bankruptcy been discharged? 
Yes   No

I hereby certify that all the statements above are true and complete and are made for the purpose of obtaining credit. I understand that if the statements are not made in good faith to be true and complete, that such is cause for denial of credit.

* I agree that E. Curtis Auto, Inc. has permission to investigate my credit history, and all other information contained in this application. (MUST BE CHECKED)

*What phone number would you like us to use when contacting you?    

*Applicant Name        *Date