CONGRATULATIONS ON DECIDING TO APPLY FOR AN AUTO LOAN AT BRAZOS VALLEY AUTO SALES
e-mail address_____________________________________

NAME __________________________________ HOME PHONE ______________________________

SOCIAL SECURITY NUMBER_________________________ DATE OF BIRTH ___ / ___ / ___

PRESENT ADDRESS _________________________________________________________________________

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Move-in Date

PREVIOUS ADDRESSES
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EMPLOYER ___________________________________________ EMPLOYER PHONE _______________________
EMPLOYER ADDRESS _________________________________________________________________________________
START DATE ________________ POSITION _____________
SUPERVISOR ___________________________ NET INCOME $_________________ PER ________________
ADDITIONAL INCOME $___________________ PER _______________ SOURCE _______________________
Alimony, Child Support, or Separate Maintenance Income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Is any income in this section likely to be reduced in the next two years or before the requested credit is paid off? __________
If yes, please explain on a separate sheet.
PREVIOUS EMPLOYMENT
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MARRIED ___ SEPARATED ___ UNMARRIED (Including single, divorced, and widowed) ___

How soon do you need to buy a vehicle? ____________________________________________________
Of the vehicles featured on our website, which three are most appealing, and why? __________________
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How much cash do you plan to use as a down payment? _______________________________________
Do you plan to trade in a vehicle? ______ If so, please describe it: ____________________
Last Vehicle Financed __________________ Name of Lienholder ________________
Balance owed or date paid _____________________________ Monthly Payment Amount ____________
Are you trading in this vehicle? ______________________
Have you ever had property repossessed?________________ If yes, please explain: ___________
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Have you ever declared bankruptcy? __ If yes, please state when and where on a separate sheet.
Have you consulted with an attorney about filing bankruptcy? __
Are you contemplating filing bankruptcy? __