| Dealership Information |
| Date: |
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Dealer Name: |
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| Dealer Fax: |
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Dealer Phone Number: |
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| Salesperson: |
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Dealer ID: |
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| Equipment Information |
| Vehicle 1 |
| Manufacturer Make: |
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Manufacturer Model: |
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| VIN/Serial Number: |
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Price: |
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| Vehicle 2 |
| Manufacturer Make: |
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Manufacturer Model: |
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| VIN/Serial Number: |
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Price: |
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| Any Dealer Items or Accessories : |
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| Axle Size: |
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Number Of Axles: |
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| Tire Size: |
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Total (Vehicles 1, 2 and Dealer Items): |
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Less Cash Down Payment: |
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Less Trade-In: |
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Total Requested: |
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| Section A |
| Applicant Information: |
| First Name: |
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Last Name: |
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| Address: (Not PO BOX) |
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| Apartment #: |
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| City: |
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Years at Address: |
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| State: |
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ZIP Code: |
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| Phone #: |
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Cellular Phone #: |
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| Social Security #: |
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Date of Birth: |
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| E-mail Address: |
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| Mailing Address: (if different from above) |
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| Apartment #: |
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| City: |
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| State: |
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ZIP Code: |
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| Employment Information / Self-Employed: |
| Current Employer: (If Self-Employed, Name of Business) |
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Business Phone #: |
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| Employer Address: |
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| How Long?: (Yrs. - Mos.) |
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Position: |
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| City: |
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State: |
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| ZIP Code: |
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| Gross Monthly Income: |
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Is Loan to be in Business Name Above?
(Guaranty Agreement Required) |
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| Other Contact Information: |
| Name of Nearest Relative not Living with You: |
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| Phone Number: |
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| City: |
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State: |
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| ZIP Code: |
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| Bank Information: |
| Bank Name: |
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State Where Account Started: |
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| IMPORTANT INFORMATION ABOUT ACCOUNT OPENING PROCEDURES: Federal requires all financial institutions, prior to account opening, to obtain, verify and record information that identifies each person who asks to open an account prior to account opening.
WHAT THIS MEANS TO YOU: When you apply for credit, we will ask your name, address, date of birth, and other information that will allow us to identify you. We may also to see your driver's license or other identifying documents. Failure to provide the required information may result in denial of your request to open an account. |
| Joint Applicant Information: |
| First Name: |
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Last Name: |
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| Address: (Not PO BOX) |
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| Apartment #: |
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| City: |
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Years at Address: |
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| State: |
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ZIP Code: |
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| Phone #: |
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Cellular Phone #: |
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| Social Security #: |
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Date of Birth: |
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| E-mail Address: |
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| Mailing Address: (if different from above) |
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| Apartment #: |
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| City: |
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| State: |
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ZIP Code: |
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| Joint Employment Information / Self-Employed: |
| Current Employer: (If Self-Employed, Name of Business) |
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Business Phone #: |
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| Employer Address: |
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| How Long?: (Yrs. - Mos.) |
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Position: |
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| City: |
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State: |
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| ZIP Code: |
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| Gross Monthly Income: |
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Is Loan to be in Business Name Above?
(Guaranty Agreement Required) |
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E-Sign Act Notice Of Delivery Of Disclosures Federal regulation requires financial institutions to inform loan applicants that certain disclosures related to this application could be delivered electronically (e.g., screen display). Should the application be denied, Notice of Adverse Action will be sent to the applicant(s) via U.S.
Postal Service. Should the application be approved and applicant(s) enter into a loan with us through the dealership of their choice, copies of loan-related disclosures will be provided to them by the dealership where the transaction is completed.
Applicant(s) understand and agree to these disclosures
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| Check the Box if You Agree:
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Disclosure Information This Application for Credit ("Application") is to Rock Solid Funding, LLC (Broker). I have read this Application and everything stated in it is true. I authorize Rock Solid Funding, LLC, to check my credit, employment history, or any other information, and to report such information to third party lenders
for the specific purpose of securing a loan or lease. I am at least 18 years of age.
IMPORTANT INFORMATION ABOUT ACCOUNT OPENING PROCEDURES: Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who requests to open an account prior to account opening.
WHAT THIS MEANS TO YOU: When you apply for credit, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. Failure to provide the required information may result in denial of your request to open an account.
Applicant(s) understand and agree to these disclosures |
| Check the Box if You Agree:
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