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Tell us about yourself

First Name	_____________________	Enter your first name. Alpha characters only.
Middle Initial	_____	Enter your Middle Initial. Alpha characters only.
Last Name	__________________________	Enter your last name. Alpha characters only.
Street Address	__________________________	We need a valid residence address. If you have an apt/suite #, please enter it as part of the street address. We do not accept PO box addresses.
City	________________________	Enter the city you reside in.
State	________________________	Select the state you reside in.
Zip Code	______________________	Enter the 5 digit US Zip code where the vehicle will be garaged. We use this zip code to provide you the most applicable incentives offered.
Social Security Number	_____-_____-_____	We need your social security number, so that we can pull a credit bureau and assess your credit worthiness.
Date of Birth	_____/_____/_______	Enter as MM/DD/YYYY
Are You Retired?	No __Yes __	Enter yes or no.
Income	__________Per Pay Period	Enter your gross income. Alimony, child support or separate maintenance income need not be included if you do not wish to have it considered as a basis for repaying this obligation.
Pay Period	Weekly__Biweekly__Monthly__	Select a pay period choice from the drop down to coincide with the gross income that you indicated in Income above. For example, if you entered a weekly income, select weekly for your pay period. If you entered a monthly income, then select monthly for your pay period, etc.
Time at Employer	___Years ___Months	Let us know how long you've been employed by your current employer.
Residence info	___Rent___Buy___Own	Are you renting or buying your home? Perhaps, you've already paid it off. Please let us know.
Rent/Mortgage Payment	$________	Please provide the accurate monthly rent or mortgage payment. Include any payments you make on a home equity line of credit for the same residence. You can include real estate taxes and insurance as part of the monthly payment amount.
Time at Residence	Years Months	Please enter the time at your current residence.
Home Phone Number	___ - ___-_____	.Enter only numeric characters.
Work Phone Number	___-___-_____	Enter only numeric characters. If you're retired, reenter home phone number.
Employer Name	_________________________	Enter the name of your employer. If you’re retired, please enter your last employer.
Occupation	_________________________

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