PAUL WEST USED CARS APPLICATION

Thanks for taking the time to apply with us and give us the opportunity to serve you.

The Application below gives us information about you: General Info, Employment Info, Additional Info, and Vehicle Info.

APPLICANT FIRST NAME
APPLICANT MIDDLE INITIAL
APPLICANT LAST NAME
APPLICANT DATE OF BIRTH	JAN 01 FEB 02 MAR 03 APR 04 MAY 05 JUN 06 JUL 07 AUG 08 SEPT 09 OCT 10 NOV 11 DEC 12    01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
APPLICANT SOCIAL SECURITY #	example: XXX-XX-XXXX
CO-APPLICANT FIRST NAME
CO-APPLICANT MIDDLE INITIAL
CO-APPLICANT LAST NAME
CO-APPLICANT DATE OF BIRTH	JAN 01 FEB 02 MAR 03 APR 04 MAY 05 JUN 06 JUL 07 AUG 08 SEPT 09 OCT 10 NOV 11 DEC 12    01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
CO-APP SOCIAL SECURITY #	example: XXX-XX-XXXX
ADDRESS
APARTMENT #
CITY, STATE, ZIP	FL AK AL AR AZ CA CO CT DC DE GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
HOME PHONE	example: 352-555-4659
CELL PHONE	example: 352-555-4659
EMAIL
MONTHLY PAYMENT	MORTGAGE    RENT
TIME AT RESIDENCE	YEARS        MONTHS
TIME IN AREA	YEARS        MONTHS
LANDLORD'S NAME
LANDLORD'S PHONE	example: 352-555-4659

APPLICANT EMPLOYMENT:

APPLICANT EMPLOYER
HOW LONG ON JOB?	YEARS        MONTHS

PHONE NUMBER

example: 352-555-4659

TAKE HOME PAY?

WEEKLY  BI-WEEKLY   SEMI-MONTHLY

OTHER INCOME

CHILD SUPPORT   SSI   RETIREMENT   OTHER

CO-APPLICANT EMPLOYMENT:

APPLICANT EMPLOYER
HOW LONG ON JOB?	YEARS        MONTHS

PHONE NUMBER

example: 352-555-4659

TAKE HOME PAY?

WEEKLY  BI-WEEKLY   SEMI-MONTHLY

OTHER INCOME

CHILD SUPPORT   SSI   RETIREMENT   OTHER

ADDITIONAL INFO:

APPLICANT FL DRIVERS LICENSE #

example: XXXX-XXX-XX-XXX-X

CO-APP FL DRIVERS LICENSE #

example: XXXX-XXX-XX-XXX-X

VEHICLE INFORMATION:

DESIRED VEHICLE?

WHAT DATE ARE YOU LOOKING TO GET VEHICLE?

example: 02/10/11

ARE YOU TRANSFERRING A TAG?	YES   NO
EXPIRATION DATE ON TRANSFERRED TAG	JAN 01 ------- FEB 02 MAR 03 APR 04 MAY 05 JUN 06 JUL 07 AUG 08 SEPT 09 OCT 10 NOV 11 DEC 12    01 -- 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   ---- 2012 2014 2013 2011

        - Denotes Required Fields

****   I certify that the information provided on this page to be true and accurate information. By pressing submit on this form, I authorize the dealer to begin a credit investigation and process my application. ****