Financing
 

 

  Please complete the application below. All fields marked with an * are required. If you have any questions or  concerns, click here to send an email.

On Line Application Form

First Name : 

  *

Full Middle Name : 

  

Last Name : 

  *

Social Security No. : 

  * All digits, no dashes (-)

Date of Birth : 

  MM*      DD*   YYYY*
     

Email Address : 

  *

Phone Number : 

  *
     

Address : 

  *

City : 

  *

State : 

  *

Zip Code : 

  *

 

    
Years and month   
at Address : 
 year(s)            month(s)  *

Housing Status : 

 Rent Mortgage 
Live with Relatives *

Monthly Housing   
 Payment : 

  *  

 

    

Present Employer : 

  *
Employer Phone : 
  *
Employer City : 
  *

Length of    
Employment : 

 year(s)  month(s)  *
   

Current Position : 

 *

Monthly Income : 

 * 
  (W2 Gross Monthly Income)

Other Income : 

 *
  (Per Month)
   

Vehicle Desired : 

    
  New Used

Desired Year : 

Desired Make : 
Desired Model : 
   

Down Payment : 
   

If Trade-In : 

  

Describe Trade In : 

Year : 

  

Make : 

Model : 

Mileage : 

Balance Owed : 
   
By submitting this application, I certify that all information herein is true and complete. I authorize Carex International and/or its agents to retain this application, to rely on the foregoing, to check and verify my credit, employment and salary history, and to secure follow-up reports concerning my creditworthiness.

Yes, I give you authorization No, I do not give you authorization

 
Please contact me as soon as possible regarding this matter.

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