UNDER SIX MONTHS
SIX MONTHS TO A YEAR
ONE YEAR
TWO TO THREE YEARS
MORE THAN THREE YEARS
MY PRESENT PART TIME EMPLOYMENT HAS BEEN FOR…
DOES NOT APPLY TO ME
UNDER SIX MONTHS
SIX MONTHS TO A YEAR
MORE THAN A YEAR
MY EMPLOYMENT STATUS IS…
FULLTIME W-2 EMPLOYEE AND CAN SUPPLY A CURRENT PAY
STUB WITH YEAR TO DATE EARNINGS
SELF EMPLOYED FOR TWO OR MORE YEARS WITH TWO OR
MORE YEARS OF TAX RETURNS PREPARED BY A CPA
SELF EMPLOYED LESS THAN 2 YEARS
CURRENTLY IN THE MILITARY AND ABLE TO PROVIDE (LES)
RETIRED AND CAN PROVIDE AWARD LETTER
OTHER (AND CAN PROVE INCOME)
I HAVE LIVED AT MY PRESENT ADDRESS FOR…
UNDER SIX MONTHS
SIX MONTHS TO A YEAR
ONE YEAR
TWO TO THREE YEARS
MORE THAN THREE YEARS
MY PRESENT RESIDENTIAL STATUS IS…
HOME OWNER
LEASE/RENT
LIVE WITH FAMILY
LIVE WITH FRIEND
MY LAST CAR LOAN WAS…
SIX MONTHS TO A YEAR AGO
ONE YEAR AGO
ONE TO TWO YEARS AGO
TWO TO THREE YEARS AGO
MORE THAN THREE YEARS
MY LAST CAR LOAN WAS WITH…
GMAC, CHRYSLER, FORD (PRIMUS), HONDA, TOYOTA, MITSUBISHI, MAZDA
CREDIT UNION
AMERICREDIT, CAPITAL ONE, HOUSEHOLD, OR WELLS FARGO
ARROW OR MIDWEST
OTHER BANK
BUY HERE PAY HERE
NEVER HAD A CAR LOAN
HAVE YOU EVER HAD AN AUTO REPOSSESSED?
NEVER
UNDER ONE YEAR AGO
1-3 YEARS AGO
OVER THREE YEARS AGO
MY MONTHLY GROSS INCOME IS…
LESS THAN $1400.00
$1500.00 - $1600.00
$1700.00 - $2000.00
$2100.00 - $3000.00
$3100.00 OR MORE
DO YOU HAVE ANY GARNISHMENTS ON YOUR CHECK?
YES
NO
HAVE YOU EVER HAD A CHAPTER 7 BANKRUPTCY?
NEVER
NOT DISCHARGED YET
DISMISSED
DISCHARGED LESS THAN A YEAR AGO
DISCHARGED ONE TO THREE YEARS AGO
DISCHARGED THREE PLUS YEARS AGO
HAVE YOU EVER HAD A CHAPTER 13 BANKRUPTCY?
NEVER
NOT DISCHARGED YET
DISMISSED
DISCHARGED LESS THAN A YEAR AGO
DISCHARGED ONE TO THREE YEARS AGO
DISCHARGED THREE PLUS YEARS AGO
DO YOU HAVE MULTIPLE BANKRUPTCIES?
DOES NOT APPLY
YES
HAVE YOU ESTABLISHED ANY CREDIT CARDS AFTER THE BANKRUPTCY?
DOES NOT APPLY (NEVER FILED BANKRUPTCY)
NONE
ONE ACCOUNT
ONE TO THREE ACCOUNTS
MORE THAN THREE ACCOUNTS
HAVE YOU ESTABLISHED ANY CAR LOANS AFTER THE BANKRUPTCY?
DOES NOT APPLY (NEVER FILED BANKRUPTCY)
NONE
ONE ACCOUNT
ONE TO THREE ACCOUNTS
MORE THAN THREE ACCOUNTS
THE TOTAL CASH I HAVE AVAILABLE FOR A DOWN PAYMENT IS…
OVER $4000.00
$3000.00 TO $4000.00
$1500.00 TO $3000.00
$1000.00 TO $1500.00
LESS THAN $1000.00
MY PAYMENT HISTORY ON MY MORTGAGE IS…
DOES NOT APPLY
NEXT TO PERFECT
SOME 30 DAYS LATE
SOME 60 PLUS DAYS LATE
FORECLOSURE
REDEEMED FORECLOSURE
MY PAYMENT HISTORY ON MY CAR IS…
DOES NOT APPLY
NEXT TO PERFECT
SOME 30 DAYS LATE
SOME 60 PLUS DAYS LATE
REPOSSESSION
REDEEMED REPOSSESSION
MY PAYMENT HISTORY ON MY CREDIT CARDS IS…
DOES NOT APPLY
NEXT TO PERFECT
SOME 30 DAYS LATE
SOME 60 PLUS DAYS LATE
CHARGE OFF
DO YOU HAVE STUDENT LOANS OUTSTANDING
DOES NOT APPLY
YES BUT PAYING NOW
THEY ARE NOT IN REPAYMENT
CHARGE OFF OR IN COLLECTION
DO YOU HAVE ANY OUTSTANDING MEDICAL BILLS?
YES
NO
DO YOU HAVE ANY OUTSTANDING TAX LIENS?
YES PAYING NOW
YES BUT NOT PAID
NO
PAID
DO YOU HAVE ANY OUTSTANDING CHILD SUPPORT?
YES
NO
CAN YOU PROVIDE FULL COVERAGE INSURANCE AT TIME OF DELIVERY?
YES
NO
CAN YOU PROVE YOUR RESIDENCE WITH A CURRENT BILL (UTILITY, PHONE, CREDIT CARD, OR BANK STATEMENT)?
