Last name: First name:
Initial: Birthdate:
Email address: Contact Number:
Driver's Lic. No.: Social Security No.:
Ages of Dependants: Status: Married Single Seperated
Address: Number of years at address : Homephone:
Previous address (to cover 5 years of residence): Previous address (to cover 5 years of residence):
Time at above address: Time at above address:
Lived in community : Lived in community :
Occupation or Rank: Present Employer:
Address of employment: Number of years at employment : Phone:
Previous employment (to cover 5 years history): Previous employment (to cover 5 years history):
Time at above employment : Time at above employment :
Phone: Phone:
Nearest relative not living with applicant: Address:
Phone: Relationship:
Income : Applicants gross monthly income from employment :
Personal friends known for over one year. (1): Phone: Address:
Personal friends known for over one year. (2): Phone: Address:
In the following sentence, the applicant/co-applicant is referred to as "I" and the creditor is referred to as "you and your", I, undersigned (1) make the above representations, which are certified correct, for the purpose of securing credit; (2) authorize financial institutions to obtain consumer credit reports on me periodically and to gather employment history as they consider necessary and appropriate; (3) authorize your affiliates to obtain consumer credit reports on me; (4) I authorize the dealer's assignee to share and use information about me, including information in my application, with other entities that are related to it by common ownership or affiliated with it by common control. You are notified pursuant to the Fair Credit Reporting Act, that your application may be submitted to any financial institution that is affiliated with Skyline Leasing & Sales that they may deal with.
