Quick Credit Check Authorization

Your Full Name

Your Social Security Number Date of Birth

Home Address   City   State   ZIP

Home Phone   Other Phone

How long at this address?  Years     Months

Do you rent or own your home?    Monthly Payment

Landlord/Mortgage Company Name   Phone

Where do you bank? 

Check one or both:  Checking Account    Savings Account 

Current Employer

Date you started work there   Work Phone

How do you get paid?  Weekly   Bi-weekly   Monthly   (Circle One)

Gross Monthly Income, Before Taxes   Is it direct deposited?  Yes No  (Circle one)

Are you paid hourly, salary or other?  (Circle one)

Job Title   Supervisor's Name   Phone

Additional Monthly Income:    Source:  __________________________________

Your cash down:           Email address:

Vehicle preference:        1st:            2nd: 

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Signature  ______________________________________________  Date Signed:  ______________

I certify that I am the person who completed this form and this information is true.  I authorize The Car Shop or its assigns to complete a credit bureau investigation report.

PLEASE PRINT THIS FORM AND FAX THE SIGNED COPY TO (919) 954-8116.  THANK YOU!