Credit Application

Year: 2003
Ext Color: Black
Make: Mercedes-Benz
Int Color: Black
Model: G-Class
Buy It Now Price: $54990.00
Mileage: 80189
Contact: Levon Moosakhanian
Stock #: 10436C
Phone: (301) 232-0341
VIN #: WDCYR49E23X140801
Is this to buy or lease?
If lease, miles per year:
Trade in:
Down Payment/Trade-In:

Applicant Information

Personal information is used for vehicle loan approval only and not given out for any other purpose.

First Name:
Address:
Middle Name:
Address 2:
Last Name:
City:
Social Security #:
State:
Date of Birth
Zip:
Email Address:
Residence Status:
Home Phone:
Monthly Rent/Mortgage:
Mobile Phone:
Length at Residency: yrs mos
Driver's License Number:
Driver's License State:
Driver's License Expiration

Previous Address (if less than 2 years at current address)

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Address 2:
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State:
Zip:

Employment Information

Employer:
Employer City:
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Gross Monthly Income:
Position:
Other Monthly Income:
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Other Income Source:
Length of Employment: yrs mos

Income from Alimony, Child Support or Separate Maintenance Payments need not be revealed if you do not choose to have it considered as a basis for repaying this obligation.

Previous Employer if less than 5 years at current employer

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Employer City:
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Length of Employment: yrs mos

Other Comments

CUSTOMER ACKNOWLEDGEMENT: