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Jul 19, 2018

Selected Motors Credit Application

Please fill out all the information in the following application form. then Click submit button to send you request, or print this application and fill out then fax or mail to us. A customer support representative will respond back to you via phone or e-mail by the end of next business day. To print this form click on Printable Form.

Personal Information:

*Last Name: *First Name:
*Home Phone: *Work Phone:
*Home Address:
*City: *State: *Zip:
*Years at this address: *Rent / * Own *Monthly rent / Pay:

If the current residency is less than five years please provide us previous address.

Previous Address:
City: State: Zip:

Employment Information:

*Employer Name: *Employer Phone:
*Employer Address:
*City: *State: *Zip:
*Salary: *Other Incomes:


Additional information or comments: How did you hear about us:

Approval Information:

I give the above information for the purpose of obtaining credit and I authorize your dealer and any of affiliate to verify this information including obtaining credit bureau report(s). I certify this information to be true and correct. I understand this application is subject to final credit approval at the dealership.

* 9 + 3 = Printable Form

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