(336) 622-7882 - Office
(336) 622-7883 - Fax
420 S. Greensboro St. | Liberty, NC 27298

Secure Credit Application

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Credit Information
Loan Information
Personal Information
Full Name
Marital Status:
Social Security #: - -
Drivers License & Exp Date - / /
Date of Birth: / /
Email Address:
Home Phone: eg: 234-555-1212
Cell Phone: eg: 234-555-1212
Street 1:
Rent, Own, Other:
City / State / Zip:
Date you started living at this address: / /
Have you lived at the above address for more than 5 years? yes     no
Previous Address
Financial Information
Current Employer
Previous Employer (if less that 2 years at current job)
Additional Income
NOTE: 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.
Spouse's Personal Information
Spouse's Previous Address
Spouse's Financial Information
Spouse's Current Employer
Spouse's Previous Employer (if less that 2 years at current job)
Spouse's Additional Income
NOTE: 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.
Financial Debts / Obligations
Type of Debt Holder Balance Monthly Payment
Personal References
Relationship Name Address Phone

Check this box to authorize us to share your nonpublic personal information with affiliated and/or nonaffiliated third parties. I understand that in checking this that you may be better able to serve me and that I may receive offers for other products and services that may be of value to me. Please read our privacy policy for more information regarding your rights and how we use the personal information you submit to us.


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FAIR CREDIT REPORTING ACT DISCLOSURE:

This application for credit may be submitted by the Dealer to various financial institutions. Before this application is submitted, the Dealer will disclose to you the name and address of the institution(s) who will receive copies of this application.


By clicking on the 'submit' button below I certify that the above entered information to be true and correct and I hereby authorize you to use this information to perform a credit rating check of my personal credit. I also certify that I am over the age of 18 and am a current U.S. citizen or permanent resident. In addition, I understand that submitting the above information does not represent an obligation by any party to provide credit nor does it obligate me to accept any credit offered.


     


Debbie's Automotive & 4 Wheel Drive, LLC

Debbie's Automotive & 4 Wheel Drive, LLC
420 S. Greensboro St.
Liberty, NC 27298

(336) 622-7882 - Office
(336) 622-7883 - Fax
Mon: 7:30AM - 5:30PM
Tue: 7:30AM - 5:30PM
Wed: 7:30AM - 5:30PM
Thu: 7:30AM - 5:30PM
Fri: 7:30AM - 5:30PM
Sat: 8:00AM - 12:00PM
Sun: CLOSED
Customer Satisfaction is Job One ! ! !