Secure Credit Application

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Drive America
18893 US Route 11
Watertown, NY 13601
(315)785-9700

Customer Satisfaction is Job One ! ! !

Email Us

Email us using your online webmail account

GMail

Hotmail

Use desktop email (Outlook, Thunderbird, etc...)
sales@go2driveamerica.com

Loan Information

Vehicle you are interested in:
Purpose of loan:
Loan amount requested:
Desired # of monthly payments:
Desired monthly payment:
Amount Down:

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:
Street 2:
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
Street 1:
Street 2:
City / State / Zip:
Date you started living at this address:	/ /

Financial Information
Current Bank:
Bank's Address:
Check all that apply:	checking savings loan credit card other
Have you declared bankruptcy within the last 7 years? yes no
Are you planning to file bankruptcy anytime in the future? yes no
Number of Dependants:

Current Employer
Employer Name:
Job Title:
Phone Number: eg: 234-555-1212
Date you began working there:	/ /
Gross monthly income before taxes:

Previous Employer (if less that 2 years at current job)
Previous Employer:
Previous Job Title:
Phone Number: eg: 234-555-1212
Date you began working there:	/ /

Additional Income
Additional Monthly Income:
Additional Monthly 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 Full Name
Spouse's Social Security #:	- -
Spouse's Drivers License & Exp Date
Spouse's Drivers License & Exp Date	- / /
Spouse's Date of Birth:	/ /
Spouse's Email Address:
Spouse's Home Phone: eg: 234-555-1212
Spouse's Cell Phone: eg: 234-555-1212
Street 1:
Street 2:
City / State / Zip:
Date your spouse started living at this address:	/ /
Has your spouse lived at the above address for more than 5 years? yes no

Spouse's Previous Address
Street 1:
Street 2:
City / State / Zip:
Date your spouse started living at this address:	/ /

Spouse's Financial Information
Spouse's Current Bank:
Spouse's Bank Address:
Check all that apply:	checking savings loan credit card other
Has your spouse declared bankruptcy within the last 7 years? yes no
Is your spouse planning to file bankruptcy anytime in the future? yes no
Number of Dependants:

Spouse's Current Employer
Spouse's Employer Name:
Spouse's Job Title:
Phone Number: eg: 234-555-1212
Date your spouse began working there:	/ /
Gross monthly income before taxes:

Spouse's Previous Employer (if less that 2 years at current job)
Spouse's Previous Employer:
Spouse's Previous Job Title:
Phone Number: eg: 234-555-1212
Date your spouse began working there:	/ /

Spouse's Additional Income
Spouse's Additional Monthly Income:
Spouse's Additional Monthly 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