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Covalt Investments, Inc.
903-539-1222 davecovalt76@gmail.com
Date:
APPLICANT INFORMATION
Address of property you are applying for:
First Name
Last
Cell Phone
E-mail
Birth Date (MM/DD/YYYY)
Marital Status
Social Security Number
Current Address
City, State, Zip
How long have you lived here?
Payment or rent amount (Monthly)
Landlord name or mortgage holder name
Landlord or mortgage holder phone
Are you under lease?
Yes
No
If so, what is the length of your lease?
If you have lived in your current residence for less than 3 years please give us your previous address.
City, State, Zip
How long did you live here?
Employer Information
Present Employer
Address
City, State, Zip
Monthly gross (Before taxes)
Phone
How long have you worked there?
Please provide your previous employer if you have worked at your current job for less than 3 years.
Address
City, State, Zip
Phone
How long did you work there?
ASSET & DEBT INFORMATION
Vehicle Information
Present vehicle financed
Financed through who?
Monthly payment
Credit Card(s)
Credit card company #1
Max limit
Current balance
Credit card company #2
Max limit
Current balance
Additional Information
Do you have any dependants
Yes
No
If so, how many and what are their ages?
Do you receive child support?
Yes
No
If you receive child support please tell us how much.
Do you pay child support?
Yes
No
If you pay child support please tell us how much.
Credit score (roughly)
Have you had any property repossessed ?
Yes
No
If yes, what and when?
Do you have any lawsuits pending against you ?
Yes
No
Have you ever filed for bankruptcy ?
Yes
No
If checked yes above when (MM/YYYY)
Additional Information / Additional Income
FAIR CREDIT REPORTING ACT DISCLOSURE: This application for credit may be submitted by the dealer to various financial institutions in connection with possible purchase or authorization of a vehicle contract. Upon request, names of other institutions receiving this application will be provided. The undersigned jointly and severally (1) certify the above information to be accurate and complete and intend it to be relied upon to judge creditworthiness; (2) agree that this application and all related information may be indefinitely retained whether or not credit is extended; (3) certify that the vehicle will not be used for any illegal or restricted purpose; (4) authorize consumer credit reports and investigation of asset, debt, and employment history to be obtained in connection with this application and for any update, review, collection, renewal or extension of the credit received; (5) authorize the exchange of credit, account and financial information about the undersigned, AND UNLESS THE CIRCLE THAT FOLLOWS IS MARKED, AUTHORIZE THE DEALER AND ASSIGNEEE 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 THEM 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) ¢; (6) agree to be solely responsible for making arrangements for delivery of communications to be provided to the undersigned in connection with this application; and (7) I ALSO ACKNOLEDGE RECEIPT OF A COPY OF THIS APPLICATION. Everything that I have stated in this application is correct to the best of my knowledge. You are authorized to check my credit and employment history and to answer questions about your credit experience with me. You are authorized to contact my landlord or mortgage holder and references for verification. ACKNOWLEDGMENT AND CONSENT
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