Please indicate whether the vehicle will be used primarily for: Personal or Family Purposes or Business, Commercial or Agricultural purposes Boxes A and C below are to completed by the Applicant. If this is a joint application, the joint Applicant should complete Box B. If this is not a joint application, Box B should be completed with information about the Applicant's spouse if: (1) the Applicant is replying on the spouse's income as a repayment source for the credit requested or (2) the Applicant resides in a community property state or is relying on property as a repayment source which is located in a community property state (that is, Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, or Wisconsin). When completing Boxes A and B please note that alimony, child support, or separate maintenance income need not to be revealed if you do not wish to considered a repayment source. If you reside in a community property state, please indicate whether you are: Applicant Married Separated Unmarried Joint Applicant Married Separated Unmarried If you are married and reside in a community property state, unless otherwise indicated on this application it will be presumed that all stated income and assets are community property, all ststed debts and obligations are liabilities of the community property, and this request for credit is made in the intrest of your marriage of family. A. Information Regarding Applicant:

Full Name Date of Birth Social Security Number Age of dependents Home Phone

Current Address: Street City State County Zip Code How Long? Yrs. Mos. #Yrs. in Community

Previous Address (Min. 5 yr. history) Zip Code How Long? Yrs. Mos. Business Phone

Employer Name Business Address How Long? Yrs. Mos. Occupation

Self Employed YesNo Nature of Business Gross Monthly Income Source of Other Income (Alimony, Child Support Maintenance Optional) Amount Total Gross Monthly Income

Previous Employer Name, City, State Phone How Long? Yrs. Mos. Occupation

Nearest Relative Not Living With You (Full Address) Phone Realtionship

Personal Reference (Full Address) Phone

B. Information Regarding Joint Applicant, Spouse or Other Persons:

Full Name Relationship to the Applicant (if any) Date of Birth Social Security Number

Current Address: (if different than applicant) Street, City, State Zip Code How Long? Yrs. Mos. Occupation

Employer Name Business Address How Long? Yrs. Mos. Business Phone

Self Employed YesNo Nature of Business Gross Monthly Income Source of Other Income (Alimony, Child Support Maintenance Optional) Amount Total Gross Monthly Income

Previous Employer Name, City, State Phone How Long? Yrs. Mos. Occupation

C. Financial Information - All Loans, Leases and Other Obligations (including Alimony, child support, maintenance)

Residence Buying or Own Rent With Parents Lienholder or Landlord Name Account No.       Address Original Balance Balance Owing Mo. Payment

Name and Account Number Address Original Balance Balance Owing Mo. Payment

Name and Account Number Address Original Balance Balance Owing Mo. Payment

Previous Vehicle Was Leased Purchased Name of Lessor or Financing Creditor Gross Branch Number City, State Account No. Original Balance Open Paid Trade

Checking Name Branch Phone Account No. Balance Saving Money Mkt. Name Branch Phone Account No. Balance

Have You Ever Obtained Credit Under A Different Name? Yes No (List Name & Address) Have You Ever Filed for Bankruptcy No Yes Date

The following information is not required if application is being made for retail installment credit or "Flexable Loan" credit.

List all operators in order of most frequent use:

Operator1 %of Vehicle Use Birthdate Operators License Number State Years Licensed

Operator2 %of Vehicle Use Birthdate Operators License Number State Years Licensed

Garaging Address if Other Than Residence Number and Street City State Zipcode Phone