White Dodge - South Charleston WV

WHITE DODGE CREDIT APPLICATION

Type of Application

If business, please list the business name:

Type of Credit

Individual Credit - applying for credit in your name and relying solely on your own income or assets and not the income or assets of another person as the basis for repayment of the credit requested

Joint Credit - applying for joint credit with another person. Relationship to joint applicant or other party, if any please include in the following space:

Individual Credit - applying for credit in your own name, but relying on income from alimony, child support, separate maintenance, or on the income or assets of another person as a basis for repayment of the credit requested.

First Name, M.I.
Last Name
First Name, M.I. (co-applicant)
Last Name (co-applicant)
E-Mail Address:	Required
S.S.N.
S.S.N. (co-applicant)
Date of Birth	Day Year
Date of Birth (co-applicant)	Day Year
Home Phone
FAX	If available
Current Address
Apartment #
PO Box
City
State & Zip Code
Current Address (co-applicant)
Apartment # (co-applicant)
PO Box (co-applicant)
City (co-applicant)
State & Zip Code (co-applicant)
Type of Car	Stock Number Used only! New car model:
Desired monthly payment
Please Select a Salesman	Please choose "None" if you are not sure!
Any final comments or questions, please type them below. Thank you!
If you need special financing, please check here:

By submitting the following form, you verify that you are giving White Dodge permission to check your personal credit.

You must "fully" complete this form in order for us to check your credit!

* Submittal may take a moment to go through, please be patient. *

White Dodge - South Charleston WV - 1-800-834-7379