Genesis Auto Consultants 
Your Personal Auto Purchasing Agent 
 
         386-308-3028
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Credit Application

Personal Information

*Required
Name (Mr,Mrs,Ms) (First) (Last) (Middle Intial)*

Prefix
First
Last
Suffix
Social Security Number*
Date of Birth*

MM		 /
DD		 /
YYYY
Address*

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Phone Number*
Other Contact Number (Cell or Work)
The place where you are living, are you renting,
leasing, buying or live with relative?*
Renting
Leasing
Buying
Live with Relative
Own Out Right
Other
How long have you lived at your current address?*
Less Than 6mos
6mos to 1 Yr
1 to 2 yrs
2 to 5 yrs
5 yrs +
Monthly Rent, lease or mortgage payment*

CURRENT EMPLOYMENT:

A description of the section goes here.
Employer:*
Address:*
Supervisor:*
Phone Number*
Position Title or Job Descrition*
How long have you been on you present job?
Salary*
Amount per Month BEFORE TAXES (Gross Amount)
Hourly wage is figured by taking the amount you
make per hour X the number of hours you work per
week X 4.3

Previous Position if less than 5 years at current employer.
Employer:
Address:
Phone Number
Position Title:

I certify that information contained in this application is true and complete and that I am at least 18 Yrs old. I understand that false information may lead to my loan not being approved. By sending this form and by my disclosing this information, I hereby give my consent to Genesis Auto Consultants or any financial institution that receives this application to pull my credit report and review it for consideration for an auto loan. I also authorize the verification of any or all information listed above.
I agree to the terms as stated above:*
Yes, I agree.
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