Vehicle of Interest Year (*) Make (*) Model (*) Stock # Personal Information First Name (*) Middle Initial Last Name (*) E-mail (*) Date Of Birth (*) JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 12345678910111213141516171819202122232425262728293031 19481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000 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 (*) ALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Residence Owned By RentOwn with MortgageOwn Clear Rent or Mortgage Amount (*) At Residence Since (*) JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013 Primary Income Information Income Type (*) Employee (gets W2)Self Employed (no W2)Fixed Income(SSI, AFDC etc.) UnemployedTemp Service Employee Gross Monthly Pay (Before Taxes) (*) Start Hire Date (*) JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013 Business Phone (*) Secondary Income Information Income Type Employee (gets W2)Self Employed (no W2)Fixed Income(SSI, AFDC etc.) UnemployedTemp Service Employee Gross Monthly Pay (Before Taxes) Start Hire Date JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013 Business Phone Banking Information What type of bank account(s) you have? SavingsCheckingI do not have one Refresh 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. I agree to the terms and conditions of this application and give permission to Gemre Corp to run an automotive credit check on my behalf.
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.