Section A: Applicant Information (Required Information Highlighted in GOLD)
Name (First, M.I., Last):
Street Address:
City:
State:	Select Your State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
Home Phone:
E-Mail Address:
Time at Residence:	Years: Months:
Renting Information:	Owning Renting Other
Rent/Mortgage:	$ per month
Date of Birth (mm/dd/yyyy):
Social Security Number:
Drivers Licence Number:
State:	Select Your State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Expiration Date:

Employment Information (Required Information Highlighted in GOLD)
Employer's Name:
Address:
City:
State:	Select Your State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
Business Phone Number:
Occupation:
Time At Job:	Years: Months:
Gross Monthly Income:

Other Income - Source(s) of other income: alimony, child support or separate maintenance income need not be disclosed if you do not wish to have it considered as a basis for repaying this obligation.
Additional Monthly Income:	$
Sources:

By signing this application:
1.	We restrict access to nonpublic personal information about you to those employees who need to know that information to provide products or services to you. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.
2.	I authorize Dealer, TIM STEWART FORD AND ANY FINANCE COMPANY, bank, or other financial institution to which the Dealer submits my application ("you or your") to investigate my credit and employment history, obtain credit reports, and release information about your credit experience with me as the law permits.
3.	If an account is created, I authorize you to obtain credit reports for the purpose of reviewing or taking collection action on the account, or for other legitimate purposes associated with the account.
4.	I certify that I have read and agree to the terms of this application and that the information in it is complete and true.
5.	I authorize you to start a credit investigation based on the information voluntarily provided by me which is true and correct, and release all my current debts. In addition, I authorize you to obtain federal and state records of employment and income history, including State Employment Security Agency ("SESA") records. This SESA authorization is for this transaction only and continues in effect for one (1) year unless limited by state law, in which case the authorization continues in effect for the maximum period, not to exceed one (1) year, as allowed by law. A bankruptcy proceeding is not in progress nor expected. If the attached application is submitted in the name of a business, a current and year-end financial statement, including P&L statement, and balance sheet may be required, audited if possible.

Please sign and date your application:
Signature (your initials):
Today's Date: