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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 050627 - 2009 AUDI A3 DSG - $6,495
SN e90642 - 2001 BMW 5-SERIES 530I - $5,995
SN 848238 - 1985 BUICK LESABRE LIMITED - $5,495
SN 202496 - 2006 CHEVROLET MONTE CARLO SS - $7,995
SN 173912 - 1999 CHEVROLET SILVERADO 1500 REGULAR CAB SHORT BED 2WD 4-SPEED A - $12,995
SN 164754 - 2004 CHEVROLET SILVERADO 2500HD LS - $8,495
SN 906247 - 2003 CHEVROLET TRACKER LT - $7,495
SN 361595 - 2000 CHRYSLER 300M BASE - $3,195
SN 348139 - 2006 DODGE MAGNUM R/T - $7,495
SN a15022 - 1989 FORD F450 - $3,495
SN 206954 - 2006 FORD MUSTANG GT DELUXE - $9,995
SN 147081 - 2003 FORD TAURUS SE - $3,495
SN 229666 - 2005 GMC SIERRA 1500 SLT EXTENDED CAB LONG BED 4WD - $6,495
SN 812481 - 1999 GMC SUBURBAN 1500 4WD 4-SPEED AUTOMATIC - $4,995
SN 010495 - 2005 HONDA ACCORD EX - $3,795
SN 014201 - 2002 HONDA ACCORD LX SEDAN - $2,195
SN 702340 - 2014 HONDA CIVIC SI - $9,995
SN 547196 - 2001 JEEP CHEROKEE SPORT - $8,995
SN 311820 - 2003 JEEP WRANGLER SPORT - $10,995
SN 681307 - 2007 MAZDA MAZDA3 S GRAND TOURING - $1,495
SN 175617 - 2004 MAZDA MAZDA3 S - $3,495
SN 111302 - 2006 MAZDA MAZDA5 SPORT - $4,495
SN 616637 - 2004 MERCURY MARAUDER BASE - $8,495
SN j13465 - 2001 MERCURY VILLAGER SPORT - $3,495
SN 249143 - 2013 NISSAN ALTIMA 2.5 - $3,995
SN 189345 - 2001 NISSAN ALTIMA GLE - $3,495
SN 458975 - 2009 NISSAN VERSA 1.8 S - $3,495
SN 137974 - 2005 PONTIAC BONNEVILLE GXP MECHANICS SPECIAL CYL. 1 MISFIRE - $3,795
SN 155753 - 2006 PONTIAC G6 GTP - $6,995
SN 121750 - 2001 PONTIAC GRAND PRIX GTP - $5,495
SN 139014 - 2003 PONTIAC GRAND PRIX GT - $4,995
SN 451083 - 2005 PONTIAC VIBE BASE - $3,995
SN 716902 - 2008 SUBARU FORESTER 2.5X - $6,495
SN 237593 - 2011 SUBARU LEGACY 2.5I PREMIUM - $6,995
SN 260063 - 2011 SUBARU LEGACY 2.5I PREMIUM - $7,995
SN 308452 - 2005 SUBARU OUTBACK 2.5I -
SN 435120 - 2005 SUBARU OUTBACK 3.0R L.L.BEAN EDITION - $6,495
SN 618054 - 2001 SUBARU OUTBACK LIMITED - $2,495
SN 837264 - 2008 SUBARU OUTBACK SPORT - $4,995
SN 044096 - 2005 TOYOTA SIENNA LE - $4,995
SN 785009 - 2001 TOYOTA TACOMA BASE SB - $8,995
SN 414761 - 2014 VOLKSWAGEN JETTA S - $8,495
SN 313162 - 2006 VOLKSWAGEN NEW BEETLE 2.5 2-DOOR CONVERTIBLE 2.5-LITER 5-CYCL - $4,995
Purpose of loan:
Loan amount requested:
Desired # of monthly payments:
Desired monthly payment:
Amount Down:
Personal Information
Full Name
JR
SR
III
IV
Marital Status:
Single
Married
Divorced
Widowed
Separated
Social Security #:
-
-
Drivers License #:
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:
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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
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:
/
/