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Birthday
Month
Day
Year
State
Rent or Own
SoCal Auto Brokers Sales Rep
Have You Ever Had Any Property Repossessed Within The Past 7 Years?
Yes
No
Do You Have Any Law Suits pending Against You?
Yes
No
Have You Ever Filed Bankruptcy Or Is A Bankruptcy Proceeding In Progress Or Expected?
Yes
No

I, the undersigned (1) Make the above representations, which are certified correct, for the purpose of securing credit; (2) Authorize financial institutions to obtain consumer credit reports on me periodically and togather employment history as they consider necessary and appropriate; (3) Authorize your affiliates to obtain consumer credit reports on me; (4) Unless the circle that follows is marked, I authorize the dealer and any assignee or other person to whom this application is submitted to share and use information about me, including information in my application, with other entities that are related to them by common ownership or affiliated by common control. If the circle is marked, I direct the dealer and any assignee or other person to whom this application is submitted not to give information to such entities (other than information on their own transactions and experiences.) (5) Understands that we or any of the financial institution named below may be requested to purchase a sales finance contract written, or to be written, in connection with your purchase. You are notified pursuant to the Fair Credit And Lending Act.

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