Business Credit Application

Preferred Salesman:

What is the vehicle you are interested in:

Year:

Make:

Model:

Trim (if known):

Primary Applicant: Personal Information

First Name: *

Middle Initial: *

Last Name: *

Address: *

City: *

State: *

Zip: *

Time at Residence:*

Years: Months:

Phone: *

E-mail: *

Date of Birth: *

Month: Day: Year:

Social Security Number: *

Driver’s License Number: *

State: *

Dwelling Information

Please Check Oneof the Following:

Own Home Outright
Buying Home
Living with Relatives
Leasing/Renting
Own/Buying Mobile Home

Name of Landlord orMortgage Holder:

Address of Landlord orMortgage Holder:

Rent or MortgagePayment:

$

Education Information

Education Level:

Four Year College Degree or Higher
Two Year College Degree
Special Training or Trade School
Some College
High School Graduate

Employer Information

Your Current Employer:

Address:

City:

State:

Zip:

Your Position:

Time on Job:

Years: Months:

Gross Annual Income:

Before Taxes

Other Income:

Source of Other Income:

Banking Information

Name of Bank:

Please CheckAll that Apply:

Checking & Savings
Checking Only
Savings Only
Other
None

Do You Have Any Current Auto Loans?

Yes No

Name of Creditor:

Current Unpaid Balance:

$

Have You Had Any Previous Auto Loans:

Yes No

Name of Creditor:

Date Opened:

Monthly Payment Amount:

$

Amount Borrowed:

$

Date Closed:

Have You Ever Had a Car or Other Merchandise Repossessed?

Yes No

If Yes, Date of Repossession:

Have You Ever Had a Bankruptcy?

Yes No

Has the Bankruptcy been Discharged?

Yes No

If Yes, Date of Discharge:

Fair Credit Reporting Act Disclosure

Privacy Notice

In connection with your transaction we may obtain nonpublic personal information about you and that information is handled as stated in this notice. 1. We collect personal nonpublic information about you from the following sources: • Information we receive from you on applications or other forms • Information about your transactions with us, our affiliates or others; and, • Information we receive from a consumer reporting agency. 2. We may disclose all the information we collect, as described above, to companies that perform marketing services or other functions on our behalf or to other financial institutions with whom we have joint marketing agreements. 3. We may also disclose nonpublic personal information about you, as a consumer, customer or former customer, to non-affiliated third parties as permitted by law. 4. Further, we restrict access to your nonpublic personal information to only those employees who need to know that information to provide products or services to you. Employees cannot use your information for any other purpose. For your protection, we maintain physical, electronic and procedural safeguards that comply with federal regulations.

By clicking Submit you agree to the above statement and allow Ruxer Ford Lincoln to check your credit. If you choose not to please click on No Thanks.

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Toll Free	800-397-8937
Phone	812-482-1200
Fax	812-634-2119
Email	info@ruxer.com