AUTOMOTION FINANCING

This application is designed to be completed by the applicant(s) with the Lender's assistance. Applicants should complete this form as "Borrower" or "Co-Borrower," as applicable. Co-Borrower information must also be provided when the income or assets of a person other than the Borrower (including the Borrower's spouse) will be used as a basis for loan qualification or the income or assets of the Borrower's spouse or other person who has community property or similar rights pursuant to applicable state law will not be used as a basis for loan qualification, but his or her liabilities must be considered because the spouse or other person who has community property or similar rights and the Borrower resides in a community property state, the security property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan. The Co-Borrower should fill out a separate copy of this form.

Borrower Name *

Co-Borrower Name

Are you the borrower or the co-borrower? *

Borrower

Co-Borrower

III. Borrower Information

Borrower's Full Name (include Jr. or Sr. if applicable) *

Phone *

Date of Birth (MM/DD/YYYY) * +

Years of School *

Marital Status *

Married

Separated

Unmarried (single, divorced, widowed)

Number of Dependents (not listed by Co-Borrower)

Ages of Dependents

Present Address *

Address 2

City *

State *

ZIP *

Own or Rent? *

Own	Rent (number of years) Rent (number of years)

IV. Employment Information

Self Employed? *

Yes

Name of Employer

Phone

Address

Address 2

City

State

ZIP

Position/Title

Monthly Income (Dollars)

Years at this Job

Years employed in this line of work/profession

V. Monthly Income and Combined Housing Expense Information

Gross Monthly Income

HOURLY WAGE per hr *

social security # *

Bonuses (annual dollar amount)

Combined Monthly Housing Expense

Rental or Mortgage Obligation *

Describe Other Income

Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower or Co-Borrower does not choose to have it considered for repaying this loan.

Borrower or Co-Borrower?

Borrower

Co-Borrower

Income Source

Monthly Amount (Dollars)

VI. Assets and Liabilities

This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise, separate Statements and Schedules are required. If the Co-Borrower section is completed about a non-applicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.

How are you completing this section? *

Jointly

Not Jointly

VIII. Declarations

Answer the following. If you answer "Yes" to any questions, please explain below. *

	Yes	No
Have you been declared bankrupt within the past 7 years?	Yes	No
Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?	Yes	No
Are you a party to a lawsuit?	Yes	No
Have you directly or indirectly been obligated on any loan of which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes", provide details, including date, name, and address of Lender, FHA or VA case number, if any, and reasons for the action.)	Yes	No
Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? If "Yes", give details as described in the preceding question.	Yes	No
Are you obligated to pay alimony, child support, or separate maintenance?	Yes	No
Is any part of the down payment borrowed?	Yes	No

If you answered "Yes" to any of the preceding questions, please explain below.

Answer the following. *

	Yes	No
Are you a U.S. citizen?	Yes	No
Are you a permanent resident alien?	Yes	No

IX. Acknowlegement and Agreement

Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is approved; (7) the Lender and its agents, brokers, insurers, servicers, successors, and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Acknowledgement. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.

Borrower's Name *

Co-borrower's Name

Date (MM/DD/YYYY) * +

Report abuse