Secured Loan Application

Vehicle of Interest
Year (*)
Make (*)
Model (*)
Stock #
Personal Information
First Name (*)
Middle Initial
Last Name (*)
E-mail (*)
Date Of Birth (*)
Social Security Number (*)
Social Security information is used for approval and funding of an auto loan. This information will not be shared for any other purpose.
Cell Phone (*)
Home Number
Address Information
Address Line 1 (*)
Address Line 2
City, State, Zip Code (*)
Residence Owned By
Rent or Mortgage Amount (*)
At Residence Since (*)
Primary Income Information
Income Type (*)
Gross Monthly Pay (Before Taxes) (*)
Start Hire Date (*)
Business Phone (*)
Secondary Income Information
Income Type
Gross Monthly Pay (Before Taxes)
Start Hire Date
Business Phone
Banking Information
What type of bank account(s) you have?
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I acknowledge that pursuant to Fair Credit Reporting Act, my application will be submitted to Gemre Corporation, a California corporation, and/or any of its affiliates or subsidiaries or divisions (“Gemre Corporation”) for review with the assignment of a sales finance contract written, or to be written, in connection with my purchase. I certify that the above information is complete and accurate. I understand and acknowledge that the Gemre Corporation will retain my Credit Application whether or not it is approved. Email and Cellular Communication Consent: By initialing below I authorize and give consent to Gemre Corporation to use the email address and cellular telephone numbers I have provided on this application or which Gemre Corporation obtains to communicate with me for any purpose whatsoever, including but not limited to communication regarding my account activity, status and to collect any debt obligation I owe to Gemre Corporation. By providing a cellular telephone number on this application or to Gemre Corporation after my contract is assigned to them, I am consenting to receiving autodialed and artificial or prerecorded message calls from Gemre Corporation or their third party debtor collector at those numbers. Spouse Consent: By initialing below I authorize and give consent to Gemre Corporation to discuss my account with my spouse, if applicable, including discussing my account activity, status and payment arrangements.