Jalisco Motors Inc

Co-Applicant's Personal Information

Full Name

Relationship to Applicant

Social Security #

- -

Driver's License #

Driver's License Exp Date

Date of Birth

Email Address

Home Phone

Cell Phone

Co-Applicant's Current Address

Street 1

Street 2

City / State / Zip

Date you started living here

Co-Applicant's Financial Information

Current Bank

Bank's Address

Check all that apply

checking savings loan credit card

Previous Bankruptcy?

Previous Bankruptcy? yes no

Pending Bankruptcy?

Pending Bankruptcy? yes no

Co-Applicant's Current Employer

Employer Name

Job Title

Phone Number

Date you began working there

Gross monthly income

Co-Applicant's Previous Employer

Employer Name

Job Title

Phone Number

Date you began working there

Co-Applicant's Additional Income

Additional Monthly Income

Additional Annual Income

Check this box

to authorize us to share your nonpublic personal information with affiliated and/or nonaffiliated third parties. I understand that in checking this I give permission to receive from you communications via text, email or phone for related business matters as well as product and service offerings that may be of value to me. Please read our privacy policy for more information regarding your rights and how we use the personal information you submit to us.

FAIR CREDIT REPORTING ACT DISCLOSURE:

This application for credit may be submitted by the Dealer to various financial institutions. Before this application is submitted, the Dealer will disclose to you the name and address of the institution(s) who will receive copies of this application.

By clicking on the 'submit' button below I certify that the above entered information to be true and correct and I hereby authorize you to use this information to perform a credit rating check of my personal credit. I also certify that I am over the age of 18 and am a current U.S. citizen or permanent resident. In addition, I understand that submitting the above information does not represent an obligation by any party to provide credit nor does it obligate me to accept any credit offered.

Jalisco Motors Inc

Secure Credit Application

Fields in blue are required