Auto Dealership Loan Application

Application Preferences

Dealership Name*
Dealership Fax*
Dealership Phone*
Select a Vehicle Condition*
Do You Have a Trade In?*
Is There a Joint Applicant? *
Note: If the applicant resides in a community property state and is married, you may consider adding the personal credit information of that spouse. The spouses information is not required to be entered as a co-applicant unless he/she wants to be considered for the loan.

Applicant's Personal Credit Information

First Name * / MI
Last Name *
Social Security Number *	- -
Date of Birth (mm/dd/yyyy) *	- -
Home Phone *	- -
Cell Phone	- -

Address 1 *
Address 2
City *
State *
Zipcode *
Time at Address *	yrs. mos.
Housing Status *
Mortgage Pymt or Rent*

Applicant's Employment History

Employment Status*
Employed By *
Occupation

Time Employed*	yrs. mos.
Salary Gross (Monthly)*
Business Phone *	- -

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

Other Income (Monthly)
Source of Income
Phone Number if Applicable	- -

Financial/Collateral Information

Stock Number
VIN Number*

Vehicle Year*
Vehicle Make*
Vehicle Model*
Vehicle Trim

Term (mos.)	Cash Selling Price	Sales Tax +	T&L (Estimate) +	Cash Down -	Rebate -	Trade Allow -	Trade Payoff +	Unpaid Balance =
						Gap +	Warranty +	Est. Amt. Financed =

Invoice / MSRP	/
Book Trade / Retail NADA Clean trade (hard adds only)	/
Odometer Mileage*

Additional Comments

Prior to engaging the "Submit Application" to send this application to Pelican Resource Group, LLC, the applicant(s) has given express consent and agreed that the application may be sent electronically to Pelican Resource Group, LLC. In turn Pelican Resource Group may in turn submit this application to its affiliate financial institutions for review. Also, dealer or representative agrees that the customer has been provided a copy and/or read and agreed to all disclosures in this application process.

See Application Disclosure and Agreement