EmailMe Form - Finance Application

Dealer's Name *

APPLICANT INFORMATION

Name *

First MI Last

Date of Birth *

Social Security or TAX ID# *

Current Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Years at current address *

Payment per month *

Rent

Own

Phone *

### - ### - ####

Cell Phone

### - ### - ####

Email *

Previous Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Years at previous address *

EMPLOYMENT INFORMATION

Name of Employer *

Position / Title *

Gross income per month *

Years with Employer *

Employer Phone Number *

Alimony, child support or separation maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Other Income of Applicant

Per

Source

CO-APPLICANT INFORMATION

Name

First MI Last

Date of Birth

Social Security or TAX ID#

Current Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Years at current address

Payment per month

Rent

Own

Phone

### - ### - ####

Previous Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Years at previous address

CO-APPLICANT EMPLOYMENT INFORMATION

Name of Employer

Position Title

Gross Income per month

Years with Employer

Employer Phone Number

Alimony, child support or separation maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Other Income of Applicant

Per

Source

VEHICLE BEING FINANCED

Year *

Make + Model *

*

Demo

New

Used

TRADE-IN
Total Selling Amount

Lien Holder

TRADE-IN

Less Amount Owning

Equity

Cash

Total Down Payment

Unpaid Balance to finance

Number of Months

MSRP / Invoice

AGREEMENT TO INSURE VEHICLE

*In consideration of you extending credit to me, I hereby agree by my signature below to insure the vehicle pledged in the security thereof, If no satisfactory policy is taken out within 30 days of purchase, Bank is authorized to take said vehicle into protective custody until such insurance is obtained.

Insurer

Agent

Phone

### - ### - ####

Address

APPLICANT AND/OR CO-APPLICANT MUST BE SIGNED

Credit authorization: I/We hereby authorize CAMM financial, it's designees, assigns or potential assigns to review my/our personal and/or business credit profile provided by national credit bureaus in considering this application and for the purpose of updating, renewing, granting the extension of credit or additional credit or the collection of any late accounts and the decision is that of the financial institution, not CAMM financial, I/We hereby authorize our references to release credit information and I/We represent and warrant that the information submitted herein is true, complete and accurate, a facsimile, electronic or other copy of the authorization shall be as a valid original.

Applicant Signature *

Clear

(You may use your mouse to sign. If you have a touch screen, you may use your finger to sign.)

Date *

Co-Applicant Signature *

Clear

(You may use your mouse to sign. If you have a touch screen, you may use your finger to sign.)

Date *