Auto Credit Of Rochester offers on-line applications exclusively to New Hampshire residents. Any loan applicants residing outside of New Hampshire should call one of our sales consultants at (800) 64-POULIN.
Credit Application On-Line
Auto Credit Of Rochester Credit Application IMPORTANT: Read these directions before completing this application.
Check Appropriate Box: If you are applying for individual credit in your own name and are relying on your own income or assets and not the income or assets of another person as the basis of repayment of the credit requested.
If this is an application for joint credit with another person.
If you are applying for individual credit, but are relying on income from alimony, child support, or separate maintenance or on the income or assets of another person as the basis for repayment of the credit requested.
First Name Middle Initial Last Name Street Address City State Zip Date of Birth: Month Day Year Social Security Number Home Phone Number Work Phone Number Your E-Mail Address Do You... Own Rent Live With Other How Long? Landlord/Mortgage Holder Amount/Month$ Driver's License Number Salesman Name How much money were you planning on putting down?
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Previous Address (if less than 2 years at current address)
Employer's Name and Address How long have you been employed? Position Employer's Phone Number Monthly Salary $ Previous Employer (if less than 2 years at current employer) Other Income* Weekly Monthly Yearly Source Of Other Income *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.
Credit Experience (check all applicable): Bank Loan Dept. Store Gas Card Travel/Entertainment Card Bank Card Manufacturer's Finance Loan Finance Company Student Loan Other Payments $ to
Name and Address of nearest person not living with you Relationship Phone Number
Joint Applicant Co-Signer Information
First Name Middle Initial Last Name Street Address City State Zip Date of Birth: Month Day Year Social Security Number Home Phone Number Work Phone Number Do You... Own Rent Live With Other How Long? Landlord/Mortgage Holder Amount/Month$ Driver's License Number
Agreement and Submittal: Each person submitting this form agrees as follows: 1. CREDIT REPORT: I authorize you to obtain one or more credit reports on me to process this application and to review and/or to collect any credit extended to me. 2. VERIFICATION: I authorize you to verify all of my application information with any employer and others. 3. MY CREDIT HISTORY: I authorize you to provide any information concerning any credit account of mine to other creditors and to credit reporting agencies. 4. CERTIFICATIONS: I certify that I am of legal age, that no bankruptcy proceeding by or against me is in progress or anticipated, and that all of my application information is true and correct and reflects my current debts.
By submitting this credit application in to us, you agree to have read and understand the new Privacy Notice effective July 1st, 2001.
Everything that I/we have stated in this application is correct to the best of my/our knowledge. I/we understand that you will retain this application whether or not it is approved. I/we authorize any creditor to whom this application is forwarded to obtain any credit and employment history from any source and to answer questions about its credit experience with me/us.