FULL CREDIT APPLICATION

Bender Nissan
3000 Mabry Drive
Clovis, NM 88101
575-762-3701
bendernissan.com
This 256-Bit Secure Online Credit Application is for this company to collect information from you so they can obtain your credit score and get auto-financing for you through one of their lenders. The more accurate and detailed information you provide the better auto-financing obtained.
PRIMARY APPLICANT Print
 
PERSONAL INFORMATION
Name Prefix: 
First Name: 
Middle Name: 
Last Name: 
Name Suffix: 
Email Address: 
Day-time Phone: 
Evening Phone: 
Mobile Phone: 
Work Phone: 
Best Contact: 
Birth Date (dd/mm/yyyy): 
Social Security#: 
Marital Status: 
Number of Dependants: 
Mother's Maiden Name: 
Driver's License Number: 
Driver's License Expires: 
Driver's License State: 
 
CURRENT ADDRESS (5+ years)
Address: 
City: 
State: 
Zip Code: 
Residence Type: 
Rent Landlord: 
Mortgage Company: 
Monthly Rent/Mortgage: 
Years Stayed: 
Months Stayed: 
 
PREVIOUS ADDRESS
Address: 
City: 
State: 
Zip Code: 
Years Stayed: 
Months Stayed: 
 
FINANCIAL INFORMATION
Credit History: 
Credit Score: 
Bank Name: 
Telephone: 
Account number: 
Account Type: 
Other Payments $: 
Other Income $: 
 
COMMENTS:
 
CURRENT EMPLOYER (2+ years)
Employment Status: 
Company Name: 
Telephone: 
Job Title: 
Occupation: 
Address: 
City: 
State: 
Zip Code: 
Years Employed: 
Months Employed: 
Gross Monthly Income $: 
 
PREVIOUS EMPLOYER
Company Name: 
Telephone: 
Job Title: 
Occupation: 
Address: 
City: 
State: 
Zip Code: 
Years Employed: 
Months Employed: 
Gross Monthly Income $: 
 
FIRST PERSONAL REFERENCE
Relationship: 
First Name: 
Last Name: 
Phone: 
Address: 
City: 
State: 
Zip Code: 
 
SECOND PERSONAL REFERENCE
Relationship: 
First Name: 
Last Name: 
Phone: 
Address: 
City: 
State: 
Zip Code: 
 
THIRD PERSONAL REFERENCE
Relationship: 
First Name: 
Last Name: 
Phone: 
Address: 
City: 
State: 
Zip Code: 
VEHICLE INFORMATION
 
VEHICLE WANTED
StockID: 
VIN: 
Type: 
Year: 
Make: 
Model: 
Trim: 
Color: 
Budget Amount $: 
Buy Time Frame: 
 
TRADE-IN VEHICLE
VIN: 
Year: 
Make: 
Model: 
Trim: 
Miles: 
Color: 
Finance Company: 
Monthly Payment $: 
JOINT APPLICANT
 
Personal Information
Relationship: 
Name Prefix: 
First Name: 
Middle Name: 
Last Name: 
Name Suffix: 
Email Address: 
Day (Work) Phone: 
Evening Phone: 
Mobile Phone: 
Best Contact: 
Birth Date (dd/mm/yyyy): 
Social Security #: 
Credit History: 
Credit Score: 
Mother's Maiden Name: 
Driver's License Number: 
Driver's License Expires: 
Driver's License State: 
 
Current Address (5+ years)
Address: 
City: 
State: 
Zip Code: 
Residence Type: 
Rent Landlord: 
Mortgage Company: 
Monthly Payment: 
Years Stayed: 
Months Stayed: 
 
Current Employer (2+ years)
Employment Status: 
Company Name: 
Telephone: 
Job Title: 
Occupation: 
Address: 
City: 
State: 
Zip Code: 
Years Employed: 
Months Employed: 
Gross Monthly Income $: 
 
Previous Employer
Company Name: 
Telephone: 
Job Title: 
Occupation: 
Address: 
City: 
State: 
Zip Code: 
Years Employed: 
Months Employed: 
Gross Monthly Income $: 
 
Financial Information
Other Income $: 
OPT-IN REQUIRED: 
 
By submitting this form to Bender Nissan, 3000 Mabry Drive, Clovis, NM 88101, 575-762-3701, you certify that the information provided is complete and accurate to the best of your knowledge. Creditors receiving this application will retain the application whether or not it is approved. Creditors may rely on this application in deciding whether to grant the requested credit. False statements may subject you to criminal penalties. You authorize the creditors to obtain credit reports about you on an ongoing basis during this credit transaction and to check your credit and employment history on an ongoing basis during the term of the credit transaction. If this application is approved, you authorize the creditor to give credit information about you to its affiliates.
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