1100 E Parkway Drive • Russellville, AR 72801
(479) 967-3344 • email@parkwayautoplex.net
Application for Financing
Vehicle Information
Vehicle Type:
Mileage:
Stock Number:
Vehicle Year:
Vehicle Make:
Vehicle Model:
VIN Number:
Selling Price:
Applicant Information
You may apply for credit in your name alone, whether or not you are married.
Name:
Social Security #:
Birth Date:
Primary Phone:
Secondary Phone:
Current Residence
Current Address:
City:
State:
ZIP Code:
Residential Status:
Time at Address:
Years
Months
Rent/Mortgage Payment:
Previous Residence
Previous address info is required if you have lived at your current residence for less than 2 years.
Previous Address:
City:
State:
ZIP Code:
Current Employer
Employer Name:
Work Phone Number:
Employment Type:
Gross Monthly Income:
Occupation:
Length of Employment:
Years
Months
Previous Employer
Previous employer info is required if you have been with your current employer for less than 2 years.
Employer Name:
Work Phone Number:
Employment Type:
Previous Occupation:
Length of Employment:
Years
Months
Other Financial Info
Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for repaying this obligation.
Other Income (Monthly):
Source of Other Income:
Co-Borrower
Do you have a co-borrower?
Yes
No
Co-Borrower Info
Relationship to Borrower:
Name:
Social Security #:
Birth Date:
Primary Phone:
Secondary Phone:
Current Residence
Current Address:
City:
State:
ZIP Code:
Residential Status:
Time at Address:
Years
Months
Previous Residence
Previous address info is required if you have lived at your current residence for less than 2 years.
Previous Address:
City:
State:
ZIP Code:
Current Employer
Employer Name:
Work Phone Number:
Employment Type:
Gross Monthly Income:
Occupation:
Length of Employment:
Years
Months
Previous Employer
Employer Name:
Work Phone Number:
Employment Type:
Previous Occupation:
Length of Employment:
Years
Months
Other Financial Info
Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered as a basis for repaying this obligation.
Other Income (Monthly):
Source of Other Income:
Additional Comments
If you have additional comments or information that you would like to share with us, please include it here: