Vision Custom Car

To apply for Financing, please fill out the following form. It is required that you answer all questions, or your application will be delayed. If you have any question, or need help, please feel free to contact us.

Borrower Information

Name:

First:		MI:		Last:		Suffix:

Daytime/Work Phone:

Evening Phone:

Employment Status:

Email Address:
Confirm E-mail Address:

About Your Work

Do you own more than
25% of a business?

Yes
No

Current Employer:

Employer Address:

City: State:

Zip:

Title/Position:

Time at Current Employer:

Your Finances

Monthly Pre-Tax Salary $

Additional Monthly Income $

Source of Additional Income:

Total Liquid Assets $

Monthly Housing Cost $

Current Bank Account Type:

If you or the co-borrower have
declared bankruptcy, when
was it discharged:

Borrower Details

Mailing Address:

City: State:

Zip:

Time At Current Residence:

Rent or Own:

Date of Birth:

Marital Status:

Citizenship Status:

Social Security #

- -

Military Veteran:

Yes
No

If so, what Rank:

Number of Dependents:

Mothers Maiden Name:

By clicking "Submit," you certify that all of the information you have provided in this qualification form is true and complete. You authorize Vision Custom Car LLC and the financial institutions to whom Vision Custom Car LLC provides this information to check your credit and employment history, to answer questions regarding their credit history with you, and provide that information to credit bureaus and to return their decision to you via the Vision Custom Car system.