Online Credit Application
    The Apple Ford Internet Department prides itself in our ability to quickly and easily provide financing solutions for our customers.  We are experts in helping credit-challenged individuals obtain affordable financing for their next vehicle.
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      * fields are required.

    Application Information

    Application Information

    Identification

    Identification
    First Name: *  
    Middle Initial *  
    Last Name: *  
    Date of Birth: Month *  
    Date of Birth: Day *  
    Date of Birth: Year *  
    Social Security Number: *  

    Contact Information

    Contact Information
    Home Phone *  
    (Area Code) Work Phone: *  
    (Area Code) Daytime Phone: *  
    (Area Code) Evening Phone:  
    EMail: *  
    How would you like to be contacted? *  

    Address Information

    Address Information
    Address: *  
    City: *  
    State: *  
    Zip:  
    How long at your current residence? Years *  
    Months *  
    Do you rent or own? *  
    Mthly rent/mtg: *  
    Landlord or Mortgage Co:  
    Phone Number:  
    If less than 2 years - please complete previous history information below.  
    Previous Address:  
    Previous City  
    Previous State:  
    Zip:  
    How long at previous residence? Years  
    Months:  

    Employment History

    Employment History
    Current Employer: *  
    Gross Monthly Income (before taxes): *  
    Position/Occupation: *  
    Phone: *  
    Address *  
    City: *  
    State: *  
    Zip:  
    Job Length? Years *  
    Months *  

    If less than 2 years - please complete previous history information below.  
    Previous Employer:  
    Phone  
    Address  
    City  
    State  
    Zip:  
    Previous Job Length? Years  
    Months:  
    Previous Employer:  
    Phone:  
    Address:  
    City:  
    State:  
    Zip:  
    Previous Job Length? Years  
    Months:  

    Questionnaire

    Questionnaire
    Other Monthly Income - $:  
    Source of other income (disability, alimony, child support):  
    Bank Name  
    Branch Office:  
    Account Type:  
    Have you ever filed for bankruptcy? *  
    If yes, when:  
    Have you ever had a car or other merchandise repossessed? *  
    If yes, when:  

    Personal References:

    Personal References:
    Personal Reference  
    Relationship  
    Address  
    City and State  
    Zip:  
    Phone  
    Personal Reference  
    Relationship:  
    Address  
    City and State:  
    Zip:  
    Phone:  
    Personal Reference  
    Relationship:  
    Address  
    City and State:  
    Zip:  
    Phone:  

    Additional Info

    Additional Info
    Sales Consultant's Name:  
    Additional comments/info in the area below

    Credit Report Authorization

    Credit Report Authorization
    I certify that the information provided by me is correct. I also understand that you will be checking with credit reporting agencies. I authorize an investigation of my credit and employment history and the release of information about my credit experience. I have read and received a copy of your Privacy Notice and agree to all of the above.  
    Credit Check: *  
    (Initial here) *required *  
    • Approval based on lender criteria, Not all customers will qualify.

    Read our privacy notice - which discloses the privacy practices for Apple Ford of Lynchburg. This privacy notice applies solely to information collected by this web site.

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