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Finance Application
**PLEASE NOTE THAT THIS IS A SECURE APPLICATION WHICH DIGITALLY ENCRYPTS AND PROTECTS YOUR INFORMATION FROM BEING VIEWED BY ANYONE OTHER THAN SMART CARS BY WIELAND LTD., FOR WHOM THE INFORMATION IS INTENDED.**
A. Information About Applicant

* Denotes a Required Field   

Individual Credit - Applying for credit on your own and relying on your own income or assets of another person as the basis for repayment of the credit request (Complete Section A Only).

Joint Credit - Applying for joint credit with another person (Complete Sections A and B).  Relationship to joint applicant or other party, if any: .
 

* First Name:  

Middle Name:

Last Name:  

   
* Social Security Number:  Ex. 000-00-0000 * Date of Birth:   Ex. 00/00/00
   
* Telephone: * E-Mail Address:  
   
* Present Address:   * City:   * State:   * Zip:  
   

* I've Lived There? Years:   Months:  

* I     Rent Own Live With Relatives.
   

Previous Address:

City: State: Zip:

   

I  Lived There? Years: Months:

 
     

* Employed by:Self  Others

 * Employer Name:    
   
* Employer's Address:   * City: * State: * Zip: 
   

* Employed There? Years:   Months:  

* Employer Telephone:  
   
   

* Trade or Occupation:  

* Gross Monthly Income: $

   
Previous Employer's Name:  If at current job less than 3 years.
   
Previous Employer's Address: City: State:   Zip:  
   

Employed There? Years:   Months:  

  
 

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.
     

Other Income Type:

Source's Name:

Monthly Amount:

   
Source's Address: City: State:   Zip:  
   
Relationship: Telephone:
   
Name of Your Bank: Branch Name and City:
   
Type of Account: Checking Savings No Account Account Number:
   
Name of Creditor Who Financed Last Car:  
   
Balance Due or Date Paid: Trading This Car? Yes No
B. Information About Joint Applicant or Other Party (If Applicable)

First Name:

Middle Name:

Last Name:

   
Social Security Number:    Ex. 000-000-0000 Date of Birth:   Ex. 00/00/00
   
Telephone: E-Mail Address:
   
Present Address: City: State:   Zip:  
   

I've Lived There? Years:   Months:  

I Rent Own Live With Relatives.
   

Previous Address:

City: State:   Zip:  
   

I've Lived There? Years:   Months:  

  
     

Employed by: Self  Others

 Employer Name:  
   
Employer's Address: City: State:   Zip:  
   

Employed There? Years:   Months:  

Employer Telephone:

   

Trade or Occupation:

Gross Income: $ Monthly
   
Previous Employer's Name:  
   
Previous Employer's Address: City: State:   Zip:  
   

Employed There? Years:   Months:  

  
 

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.
     

Other Income Type:

Source's Name:

Monthly Amount:

   
Source's Address: City: State: Zip:
   
Relationship: Telephone:
   
Name of Your Bank: Branch Name and City:
   
Type of Account: Checking Savings No Account Account Number:
   
Name of Creditor Who Financed Last Car:  
   
Balance Due or Date Paid: Trading This Car?                       Yes No
   
*   I certify that the above information is complete and accurate.  I authorize Smart Cars by Wieland Ltd. to conduct an investigation of my credit and employment history.  Please indicate your compliance and understanding by clicking the button above.

 
 

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