STOP IN OR CALL 607-734-3752 FOR MORE DETAILS
Copyright 2004 Northern State Auto, Inc.  210 South Walnut Street    Elmira, New York   14904    607-734-3752        Toll  Free   888-803-8219      Web Design by Marlene Andes
CREDIT APPLICATION
Please make an entry for each field (blank)  if does not apply enter n/a or --.  IF YOU CHOOSE TO OPT OUT OF RECEIVING THE DIALOG
NOTICES FROM THIS APPLICATION AND DO NOT COMPLETE ALL BOXES WE WILL NOT BE ABLE TO PROCESS YOUR APPLICATION!!!!
LAST
NAME:
DATE OF
BIRTH:
FIRST
NAME:
SOCIAL
SECURITY #:
STREET
ADDRESS:
ZIP
CODE:
CITY:
STATE:
HOME
PHONE #:
CELL
PHONE#:
RESIDENTIAL
STATUS CHECK ONE:
RENT
FAMILY
OTHER
HOMEOWNER
DRIVER'S
LICENSE#:
STATE
ISSUED:
TIME AT
ADDRESS:
YEARS
RENT/MTG PAYMENT:
MONTHS
PREVIOUS ADDRESS IS LESS THAN
THREE (3) YEARS:
TIME AT PREVIOUS
ADDRESS
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EMPLOYER
NAME:
EMPLOYER
PHONE#:
LENGTH OF
EMPLOYMENT
MOS
YRS
EMPLOYER
ADDRESS:
GROSS
SALARY/WAGE:
OCCUPATION:
ANNUALLY
BI-WEEKLY
MONTHLY:
WEEKLY:
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PREVIOUS EMPLOYMENT IF CURRENT EMPLOYMENT IS LESS THAN THREE (3) YEARS.  IF WAS ATTENDING SCHOOL ENTER SCHOOL INFORMATION
PREVIOUS
E
MPLOYER NAME:
PREVIOUS
EMPLOYER PHONE#:
PREVIOUS EMPLOYER
ADDRESS:
LENGTH OF
EMPLOYMENT
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SOURCE OF
OTHER INCOME
OTHER INCOME:
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VEHICLE OF
INTEREST
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TRADE-IN VEHICLE:
TRADE-IN MILEAGE:
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EMAIL ADDRESS:
DOWN PAYMENT:
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The following questions are voluntary, but helps us with obtaining the financing you may need.  You do not have to answer any of the questions.  However, unless you are totally certain you can obtain a loan and/or
have a pre-arranged loan secured, the more information  provided the better chance of success will be to obtain a loan/vehicle.
Have you had or currently have car loan(s), credit
card(s), Line(s) of Credit, etc?
NO
Are you interested in purchasing an Extended Warranty?
YES
NO
YES
Are any of your expenses (ie rent, mortgage) shared
with somebody else in the household?
NO
WHICH ONES?
YES
Do you have somebody who can co-sign with you if
necessary?
IF YOU HAVE A CO-SIGNER, HAVE THEM COMPLETE AN ADDITIONAL APPLICATION AND BE SURE TO MARK ON THE
NEXT QUESTION  THEY ARE A CO-SIGNER AND FOR WHOM.
YES
NO
Are you filing as a co-signer on somebody else's
application?
YES
NO
CO-SIGNING FOR WHOM?
Are any of your circumstances going to change in the
near future and when - example less rent, more hours
at work, etc?  Please explain if yes.
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BY CHECKING THIS BOX I AM ACKNOWLEDGING THAT I AM APPLYING FOR FINANCING FOR A VEHICLE AT
NORTHERN STATE AUTO.  I AM AUTHORIZING NORTHERN STATE AUTO AND/OR THE FINANCIAL INSTITUTIONS
THEY CHOOSE TO SUBMIT MY APPLICATION TO ACCESS MY CREDIT REPORT/FILE FOR THE DETERMINATION OF
RECEIVING THE FINANCING.  I UNDERSTAND MY INFORMATION WILL BE KEPT CONFIDENTIAL BY ALL PARTIES
INVOLVED IN THIS PROCESS.