Check One: (Primary applicant and joint applicant must complete separate forms)

Primary Applicant:

Joint Applicant:

Application is for joint credit with primary applicant or as a guarantor

Primary applicant is relying on you for income, child support, or separate maintenance or on your income or assets as the basis for repayment of the credit requested.

 First Name:

 Middle Name:

 Last Name:

Jr. Sr.

Date of Birth:

Social Security #:

Driver's License #:

Driver's License State:

Physical Address (Number, Street, Apartment)

City:

County:

State:               Zip Code:

Billing Address (Number, Street, Apartment, P.O. Box)

City:

County:

State:               Zip Code:

Own Home Outright

Living with Relatives

Own/Buying

Mobile Home

Buying Home

Leasing/Renting

Current Employer/Workplace:   Work Phone:

Current Employer Address:

Applicant's Occupation:

(If military, list rank)

Gross Monthly Salary:

For the purpose of securing credit from Sparta Ford-Mercury, or one of its lending institutions,
I certify that the above information is true and complete to the best of my knowledge.