9624 E 61st Street ■ Tulsa, OK 74133 ■ Fax (918) 249-8990 ■ Phone (918) 249-8999

APPLICANT

CO-APPLICANT

Name:

Name:

Soc. Sec. #

D.O.B.

Soc. Sec. #

D.O.B. 

Address:

How  Long?

Address:

How Long?

City:

State:

Zip:

City:

State:

Zip:
Own Other   Rent Payment Own Other   Rent Payment

Home Phone:

Work:

     

Home Phone:

Work:

     

Employer:

Employer:

Position:

How Long

Position:

How Long 

Gross Monthly Income:

Gross Monthly Income:

Previous Employer:

How Long?

Phone:

Previous Employer:

How Long?

Phone:

Additional Monthly Income: 

Additional Monthly Income:

Tell Us Which Car Your Interested In:

Automobile insurance is required for the full term of the contract, at your expense, against the hazards of fire, theft, and accidental physical damage (including collision). You may choose the person through whom any insurance is obtained.

I (we) hereby certify that all statements made are true, complete and accurate. I authorize an investigation of my credit and employment history and the release of information about my credit experiences.  Upon my (our) request, Dean Bailey Auto Sales of Tulsa will tell me (us) the name and address of the any credit bureau from which it received a report on me (us).  

I (we) understand that it is a federal crime to willfully and deliberately provide incomplete or incorrect information on a loan application. 

 By Checking This Box I acknowledge this agreement and authorize Dean Bailey Auto Sales of Tulsa to submit my application to lender(s) for the purpose of securing financing.

     Applicants Signature          Date

Co-Applicants Signature          Date

 *Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as basis for 

repaying this loan.

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