800 Highway 5 South
Tipton, MO 65081
660-433-5545
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Applicant / Cosigner Information
*First Name, Middle Initial
*Last Name
*Email Address
*Day Phone Number
Evening Phone Number
Date of Birth
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Social Security Number
-
-
Driver's License
Employment Information
Employer
Occupation
Supervisor
Business Phone
Employment Status
Employed Full Time
Employed Part Time
Self Employed
Temp Service
Unemployed
Student
Retired
Fixed Income
Homemaker
Other
Employment Start Date
January
February
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April
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August
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December
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Gross Salary before taxes
$
per
Year
Month
Week
Housing Information
Address
City, State, Zip
state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
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Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Residence Move-in Date
January
February
March
April
May
June
July
August
September
October
November
December
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
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2002
2001
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1993
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1984
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1981
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1971
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1951
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1932
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1930
1929
1928
1927
1926
1925
1924
1923
1922
Residence Status
Rent
Own
Military Housing
Live with Parents
Other
Housing Payment
$
per month
Other
Available Down Payment
$
Select Vehicle(s) of Interest
20
15 Acura MDX Tech Pkg $26,999
12 BMW M3 2dr Conv
17 Buick Encore Essence $20,699
19 Chevrolet Camaro LT $28,599
22 Chevrolet Express Commercial Cutaway 3500 Van 159"
21 Chevrolet Silverado 1500 4WD LT Crew Cab $47,599
15 Chevrolet Silverado 1500 4WD LTZ w/1LZ Double Cab $33,999
15 Chevrolet Silverado 2500HD 4WD LTZ Crew Cab $51,499
15 Chevrolet Suburban LS $34,999
18 Chrysler 300 Touring L $21,960
14 Chrysler Town & Country Touring $6,995
07 Dodge Ram 2500 4WD SLT Quad Cab $11,995
11 Dodge RAM 3500 $23,890
22 Ford Bronco Base $59,999
04 Ford Econoline Wagon $8,850
08 Ford Econoline Wagon $8,950
20 Ford Edge ST AWD $29,757
11 Ford F-150 4WD Lariat SuperCrew $18,599
11 Ford F-150 Lariat $12,995
10 Ford F-150 XL $9,995
12 Ford F-150 XL $16,850
06 Ford F250 RC XL $16,950
18 Ford Fusion S $19,599
21 Ford Mustang GT Premium $48,999
16 Ford Transit Wagon $23,980
99 GMC New Sierra 1500 4WD SL Ext Cab $6,950
09 Honda CR-V LX
09 Honda CR-V LX
09 Honda CR-V LX
09 Honda CR-V LX
09 Honda CR-V LX
14 Hyundai Tucson GLS $14,799
21 Jeep Grand Cherokee 4WD Laredo E $38,599
10 Lexus IS 250 $14,999
17 Mazda CX-5 Grand Touring $25,499
21 Subaru Ascent Premium $37,899
14 Subaru Forester 2.5i $11,799
19 Toyota 4Runner SR5 Premium $41,575
20 Toyota Highlander Platinum $47,975
20 Toyota Highlander XLE $42,575
17 Toyota RAV4 Limited $30,475
19 Toyota Sienna L $33,575
19 Toyota Tacoma 4WD 4WD TRD Off Road Double Cab $41,675
19 Toyota Tacoma 4WD 4WD TRD Sport Double Cab $43,475
Comments / Questions
Terms : I certify that the above information on this application for credit and any attachments I may send regarding this application are accurate and complete. I authorize and instruct any person or consumer reporting agency to compile and furnish any information it may have that may be required for the purpose of a credit transaction and agree same information shall remain your property whether or not credit is extended. I authorize you to obtain information from others concerning my credit standing and other relevant information impacting on this application and to provide others with information about your experience with me. I understand that I must update this credit information at your request and if this credit information changes.
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