Customer Information Statement

Please fill out the form below to get pre-approved for our in-house financing.

Vehicle Ownership Information

Check this Box if Appropriate

Joint Buyer

Personal Information

Name*

First Middle Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone*

Mobile Phone

Email Address*

Date of Birth*

Current Age*

Social Security Number*

Driver's License #*

State*

Expires*

Living Arrangements*

Living There Since*

Rent or Mortgage Payment*

Your Previous Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

How long did you live there?

Employment

Current Employer Name*

Employer City State / Province / Region

Your Occupation*

Years*

Months*

Your Work Phone Number*

Earnings

Your Gross Income*

Gross Income Shown is:*

Weekly
Monthly
Yearly

Source of Other Income

Other Income Amount

How Often

Weekly
Monthly
Yearly

Previous Employer

If less than 5 years at current employer

City/State

Time on Previous Job

Years

Other

Car Shopping

Approximately how many dealerships including Econo Auto Sales did you shop prior to purchasing this vehicle?

One
Two
Three
Four or More

How Did You Find Us?

What brought you to Econo Auto Sales?

Certification

Consent Agreement*

By checking this box, I agree to the privacy policy and certification below.

Certification: For the purpose of securing credit from you, I certify that the above information is true and complete to the best of my knowledge. I further certify that I have a attained The Age of Majority. I authorize you to check my credit and employment history and to provide and/or obtain information about credit experience with me.

*Fields with an asterisk are required.

^† 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.