| When you have completed the application below,
print it by clicking your browser's print button, or
by selecting the file menu's print command. Then,
sign the application and take it to DON MEYER
FORD for processing. The DON MEYER
sales staff can assist you, answer any questions you
may have, and provide you with the results of your
application. (Sales Consultant
-- Process as normal application)
Will you be applying for credit alone or with
another person?
(Primary applicant and joint applicant must complete
separate forms)
Primary Applicant
Joint Applicant
If Joint Applicant, Relationship to Primary
Applicant:
Married Parent Other
Last Name:
Junior Senior
First Name: Middle Initial:
Number of Dependents:
Applicant's Date of Birth: Month: Day:
Year: Age:
Present Address (Number and Street):
City: State: Indiana Zip:
Phone in Applicant's Home? Yes No
Phone Number: (Area Code) () -
Own Home Outright Buying Home
Living With
Relatives
Leasing/Renting
Own/Buying Mobile Home
How long have you lived in your present location?:
Years:
Mos:
Name of Landlord or Mortgage Holder:
Address of Landlord or Mortgage Holder:
City:
State:
Zip:
Rent or Mortgage Payment: $ per month
Previous Address (If less than 2 years at present
address):
Street:
City:
State:
Zip:
How long did you live in your previous location?
Years:
Mos:
Level of Education (for those applicants under age 27
only):
4 Year College
Graduate 2 Year
College Graduate
Special Training
Some College
High School Graduate? Yes No
Current Employer Name:
Current Employer Address:
City:
State:
Zip:
Applicant's Occupation (if military, state rank):
How long have you worked for this employer? Years:
Mos:
Work Phone Number: () -
Gross Salary: $ Weekly
Monthly Yearly
Social Security Number: - -
*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.
*Source of Other Income:
*Other Income: $ Weekly
Monthly Yearly
Previous Employer's Name (If less than 5 years at
current employer):
Previous Employer's Address:
City:
State:
Zip:
How long did you work for this employer? Years:
Name of Bank:
Checking &
Savings Checking
Only Savings Only No Account
Have You Ever Filed Bankruptcy? No YesFF If
Yes, When? Month: Year:
Is Applicant Obligated to Make Alimony, Child Support
or Separate Maintenance Payments?
No Yes
If Yes, Amount to Be Paid per Month is: $
Special Notices
- For the purpose of securing credit from you,
I certify that the above information is true
and complete to the best of my knowledge. I
further certify that I have attained The Age
of Majority.
- I authorize you to check my credit and
employment history and to provide and/or
obtain information about credit experiences
with me.
WARNING: Falsification of your identification
is fraud and will be prosecuted to the fullest extent
of the law.
I acknowledge that I have read and understand
the disclosures.
Signature: _________________________________ Date:
__________
For Dealer's Use Only:
Dealer Name ______________________________________
Offering # ____________________
Application Type: ____ RETAIL ____ RCL ____ OTHER
(1) Cash Price/Cap Cost (Incl. tax, title, reg.
fees) $ ___________ (1)
(2) Down Payment/Cap Cost Reduction:
Cash $ _________ + Rebate $ _________= $
___________ (A)
Trade Allow. $ ___________ - Owed $ ___________ = $
___________ (B)
Total of Line (2) (A+B) $ ___________ (2)
(3) Unpaid Balance/Acquisition Cost
(1-2)______________________(3)
If RCL: MSRP $ ___________ /LEV $ ___________
(4) Payable in ___________ Mo. Installments of $
___________ (4)
___ New ___ Used Year: _____ Make: ___________
Model: ___________
Body Style (If used vehicle): ___________ Used Car
Miles: _______________
Vehicle Identification Number: ____________________
Stock #: ______________
Optional Equipment (If used vehicle): ____ Air ____
P/S ____ P/B ____ Auto Trans.
Other: _________________________
Trade: Year: ___________ Make: ___________ Model:
___________
Body Style: ___________
Thank you for
completing the Ford Credit Internet Application.
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