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397 Route 115
Saylorsburg, PA 18353
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Secure Credit Application
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Credit Information
Individual Credit - unmarried applicant.
Individual Credit - married applicant.
Joint Credit - with your spouse.
Joint Credit - with another applicant or cosigner who is not your spouse.
NOTE: If applying for Joint Credit with someone other than your spouse, each of you must
complete a separate application.
Loan Information
Vehicle you are interested in:
No Specific Vehicle
SN j94548 - 2004 BMW 3-SERIES 330CI - $5,495
SN 184267 - 2011 CHEVROLET EQUINOX LS - $5,995
SN 629546 - 2007 CHEVROLET HHR LT2 - $5,495
SN 402424 - 2004 CHEVROLET MONTE CARLO LS - $4,495
SN 173912 - 1999 CHEVROLET SILVERADO 1500 REGULAR CAB SHORT BED 2WD 4-SPEED A - $14,995
SN 306996 - 1997 CHEVROLET SUBURBAN K2500 - $6,995
SN 116057 - 2011 CHEVROLET SUBURBAN LTZ 1500 - $17,995
SN 624119 - 2009 CHRYSLER 300 C HEMI - $7,495
SN 438459 - 2015 DODGE DART SE - $8,995
SN 670611 - 2005 DODGE MAGNUM R/T - $7,495
SN 824589 - 2003 DODGE RAM 2500 LARAMIE - $10,995
SN 749570 - 2005 DODGE RAM 2500 SLT - $16,495
SN 186759 - 2004 DODGE RAM 3500 ST - $17,495
SN a83403 - 2001 FORD EXPLORER XLS - $4,995
SN b06112 - 2000 FORD F-250 SD XL - $7,495
SN a24066 - 2005 FORD F-350 SD XL CREW CAB 4WD DRW - $13,995
SN b36834 - 2000 FORD F-550 - $29,995
SN 210848 - 2001 FORD FOCUS ZX3 - $3,995
SN 104141 - 1995 FORD MUSTANG GT: CONVERTIBLE - $6,995
SN 151910 - 2005 GMC SIERRA 1500 SLT CREW CAB SHORT BED 4WD 4-SPEED AUT - $7,995
SN 546404 - 1997 GMC SIERRA 2500 K2500 HD SLE LB - $19,995
SN 323606 - 2004 GMC SIERRA 2500HD SLE - PROJECT VEHICLE - $4,995
SN 005519 - 2005 HONDA ACCORD EX - $4,995
SN 010497 - 2008 HONDA PILOT - $3,995
SN 247804 - 2014 JEEP CHEROKEE LATITUDE - $7,495
SN 110487 - 2004 JEEP LIBERTY SPORT - $5,495
SN 658342 - 2012 JEEP PATRIOT LIMITED - $7,495
SN 182918 - 2012 KIA SPORTAGE LX - $4,995
SN 243958 - 2002 LEXUS RX 300 - $3,995
SN 719419 - 1995 LINCOLN TOWN CAR EXECUTIVE - $13,995
SN g37834 - 2012 MAZDA MAZDA3 I TOURING - $8,995
SN 656609 - 2012 MAZDA MAZDA3 S TOURING - $8,995
SN 067641 - 2000 MERCEDES BENZ S-CLASS S500 - $4,495
SN 008857 - 2000 NISSAN MAXIMA SE - $4,995
SN 831550 - 2003 NISSAN PATHFINDER LE - $5,995
SN 155753 - 2006 PONTIAC G6 GTP - $8,995
SN 028292 - 2001 SAAB 9-3 SE 5-DOOR 5-SPEED MANUAL - $6,995
SN 131110 - 2003 SATURN ION - $4,995
SN 752557 - 2006 SUBARU FORESTER 2.5X PREMIUM - $6,495
SN 719991 - 2008 SUBARU FORESTER SPORTS 2.5X - $8,495
SN 218296 - 2012 SUBARU OUTBACK 2.5I PREMIUM - $8,495
SN 654302 - 2003 SUBARU OUTBACK H6-3.0: WAGON - $4,995
SN 515558 - 2007 SUZUKI FORENZA - $3,995
SN 220632 - 1993 SUZUKI JIMNEY - $6,995
SN 086022 - 2007 TOYOTA FJ CRUISER BASE - $13,995
SN 470675 - 2006 TOYOTA TUNDRA SR5 - $7,995
SN 312539 - 2006 VOLKSWAGEN NEW BEETLE - $6,995
Purpose of loan:
Loan amount requested:
Desired # of monthly payments:
Desired monthly payment:
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Personal Information
Full Name
JR
SR
III
IV
Marital Status:
Single
Married
Divorced
Widowed
Separated
Social Security #:
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Drivers License #:
Date of Birth:
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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:
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Have you lived at the above address for more than 5 years?
yes
no
Previous Address
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Street 2:
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Date you started living at this address:
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Financial Information
Current Bank:
Bank's Address:
Check all that apply:
checking
savings
loan
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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:
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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
JR
SR
III
IV
Spouse's Social Security #:
-
-
Spouse's Drivers License #:
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 you 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:
/
/