Financing
For information on your personal financing options, please fill out the information requested below, and then click on the "Submit" button.*

Don't be alarmed if you don't see the padlock symbol on your browser.This site posts data to an encrypted SSL server with the highest level of security.
   This page uses a secure connection to send information.
   fields are required.

Application Information

Application Information
Application Type:  
Type of application:  

If you are applying with a joint application, please have the cosigner complete the form after the primary applicant has hit Submit.  

Identification

Identification
First Name:  
Middle Initial  
Last Name:  
Date of Birth: Month  
Date of Birth: Day  
Date of Birth: Year  
Social Security Number:  

Contact Information

Contact Information
EMail:  
(Area Code) Daytime Phone:  
(Area Code) Evening Phone:  
(Area Code) Cell Phone:  

Address Information

Address Information
Address:  
City:  
State:  
Zip:  
Do you rent or own?  
Mthly rent/mtg:  
How long at your current residence? Years  
Months  

If less than 2 years - please complete previous history information below.  
Previous Address:  
Previous City  
Previous State:  
Zip:  
How long at previous residence? Years  
Months:  

Employment History

Employment History

Current Employer:  
Phone:  
Occupation:  
Gross Monthly Income (before taxes):  
Address  
City:  
State:  
Zip:  
Job Length? Years  
Months  

If less than 2 years - please complete previous history information below.  

Previous Employer:  
Phone  
Address  
City  
State  
Zip:  
Previous Job Length? Years  
Months:  

Questionnaire

Questionnaire

Other Monthly Income - $:  
Source of other income (disability, alimony, child support):  
Bank Name  
Account Type:  
Education:  
Have you ever filed for bankruptcy?  
If yes, when:  
Have you ever had a car or other merchandise repossessed?  
If yes, when:  

Personal References:

Personal References:

Personal Reference  
Relationship  
Address  
City and State  
Zip:  
Phone  

Personal Reference  
Relationship:  
Address  
City and State:  
Zip:  
Phone:  

Sales Consultant's Name:  
Additional comments/info in the area below
I certify that the information provided by me is correct. I also understand that you will be checking with credit reporting agencies. I authorize an investigation of my credit and employment history and the release of information about my credit experience. I have read and received a copy of your Privacy Notice and agree to all of the above.  
Credit Check:  
(Initial here) *required  

  • Approval based on lender criteria, Not all customers will qualify.

Read our privacy notice - which discloses the privacy practices for Apple Ford of Lynchburg. This privacy notice applies solely to information collected by this web site.

Site Map