Apply For Credit

Application Type

Type of Sale

Retail

Lease

If Joint Credit, what is the relationship to the application

Spouse

Non-Spousal

Type of Application

Individual Credit – Applying for credit in your own name and relying on your own income or assets, not the income or assets of another person, as the basis for repayment of the credit request.

Joint Credit – Applying for joint credit with another person.

Individual Credit Relying on Other Income – Applying for credit in your own name but relying on income for alimony, child support, and separate maintenance or on income or assets of another person for the repayment of credit requested. Note: If married, the spouse

Applicant Information

Last Name

First Name

Middle Name

Date of Birth

SSN

Home Phone Number

Street Address

City

State

Zip Code

How long at address?

Mortgage or Rent Payment $

Residential Status

Own

Rent

Lives With Parents

Other

Primary Cell Phone

Primary Email Address

Previous address (if less than 2 years at present address)

How long at address?

Employer

Employer Phone Number

Job Title / Occupation

Years Worked

Gross Monthly Salary

Employer’s Address

Previous employer name, address, phone number & length of employment (if less than 2 years with present employer)

Joint Application Information

Last Name

First Name

Middle Initial

Date of Birth

SSN

Home Phone Number

Street Address

City

State

Zip Code

How long at Address?

Mortgage or Rent Payment $

Residential Status

Own

Rent

Lives With Parents

Other

Previous address (if less than 2 years at present address)

How long at address?

Employer

Employer Phone Number

Job Title / Occupation

Years Worked

Gross Monthly Salary

Employer's Address

Previous employer name, address, phone number & length of employment (if less than 2 years with present employer)

Other Income Note: Alimony, child support, or separate maintenance incomes do not have to be revealed unless the applicant wishes to have such sources considered as a basis for repayment of the requested

Applicant Source of Other Income

(A) Monthly Amount $

Joint Applicant Source of Other Income

(B) Monthly Amount $

Total Other Monthly Income (A&B) $

Kia of Jackson

Apply For Credit

Application Type

Applicant Information*

Joint Application Information

Other Income Note: Alimony, child support, or separate maintenance incomes do not have to be revealed unless the applicant wishes to have such sources considered as a basis for repayment of the requested

Applicant Information