Credit Application - nickersonautosales.com

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First Name

Middle Name

Last Name

Customer Address

Date of Birth

Date 3 Reference

Social Security Number

Phone Number

Source of Income

Employer Name

Employer Address

Employer Phone Number

Monthly Rent/Mortgage- Expense

Gas Expense

Electric Expense

Water Expense

Car Note Expense

Phone Expense

Other Monthly Expenses

Reference 1- Family Member (cannot share same address)

Reference 1 – Address

Reference 1 – Phone Number

Reference 2 – Family Member (cannot share same address)

Reference 2 – Address

Reference 2 – Phone Number

Reference 3 – Friend (cannot share same address)

Reference 3- Address

Reference 3 – Phone Number

I authorize the dealership to pull my credit report. ( We do not pull credit for Buy Here Pay Here but may pull credit in the case of loan default.)

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