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First Name
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Middle Name
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Suffix ( Jr.,Sr, III)
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Last Name
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Date of Birth
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Social Security Number
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Home Phone
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Cell Phone
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Home Address
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City
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State
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Zip Code
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How long at present address?
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Years
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Months
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Mortgage/ Rent Amount
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Phone Number
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Landlord/ Mortgage Company
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Previous Address (If less than 3 years on current address)
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Any Dependants?
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Divorced
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Single
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Married
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Separated
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Marital Status (Check one)
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Employment Status
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Employer Name
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Employer Address
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Gross Monthly Income
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How Long at present job?
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Time employed in years and months
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Supervisor Name:
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Phone Number
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Job Position
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Additional Income? 2nd. Job?
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Amount?
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Previous Employer? ( If employed less
than 3 years with current employer)
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Finance source/ Bank?
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Is it Financed?
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Own a vehicle now?
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Balanced owed?
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Will you be trading it in?
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If yes , Year, Make, Model
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If yes, How much down?
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Are you putting any cash down?
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Checking
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Current Bank
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Select all that apply:
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Savings
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Direct deposit
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Your email address
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Loan
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Re-Type Email address
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Note: By initialing and submitting below you agree to the following: You are giving permission to Lynnhaven Motor Company
to obtain your consumer credit report from a Consumer Reporting Agency, and to verify all information you have supplied on
this application for credit. Your credit report may be viewed by Lynnhaven Motor Company, affiliated banks, and other
affiliated financial institutions. You are giving permission to Lynnhaven Motor Company to furnish this application to
affiliated financial institutions who may themselves obtain your credit report from a Consumer Reporting Agency.
You agree that all the information you have provided is true and correct, and you will furnish proof of such when prompted by
a loan provider. You may be contacted by a loan provider. You have the right to reject any finance offer.
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Customer Initials here>
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