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Lakeside Motors, a reputation of excellence!

Credit Application Form

General Information  *  Indicates required fields
First Name: *
Last Name: *
Email: *
Social Security #: * format:  NNN-NN-NNNN
Drivers License: *
Birthday: * format:  MM/DD/YYYY
Address: *
City: *
State: *
Zip Code: *
Home Phone: * format:  999-999-9999
Time at Residence:   Years    Months
Residence Type:
Mortgage / Rent:  $ *
Financing Information  
Down Payment:  $
Trading in Vehicle?
   Year:
   Make:
   Model:
   Mileage:
   Estimated Payoff:  $
Employment Information  
Employer: *
Gross Monthly Income:  $ *
Occupation: *
City: *
State: *
Zip code: *
Work Phone: * format:  999-999-9999
Time on Job:  Years    Months
Other Income Source:
Gross Amount: $
Additional Comments:
Captcha:  *
To prevent spamming, please enter in the numbers and letters from the box below.

 

ACKNOWLEDGMENT AND CONSENT: I certify that the above information is complete and accurate to the best of my knowledge. Creditors receiving this application will retain the application whether or not it is approved. Creditors may rely on this application in deciding whether to grant the requested credit. False statements may subject me to criminal penalties. I authorize the creditors to obtain credit reports about me on an ongoing basis during this credit transaction and to check my credit and employment history on an ongoing basis during the term of the credit.


 

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Lakeside Motors, 12715 Aurora Avenue North, Seattle, WA  98133, MAP
206 526-8950       Email: lakeside.m@hotmail.com

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