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Dealer Credit Application
1. Personal Information
Applicant's Name   # Dependents  
Social Security #   Date of Birth     (mm-dd-yyyy)
2. Current Address
Street   Phone  
City   Time at Present Address
State   Zip   Years   Months  
Own or Rent   Mortgage Bank
or Landlord      
Year purchased     (if own) Purchase Price  
Monthly Payment Balance  
3. Prior Address
State   Zip    
How Long?    
4. Nearest Relative not in Household
Name   Phone  
Street   Relationship  
State   Zip    
5. Present Employer
Company Name   Supervisor  
Street   Phone  
City   How Long Yrs   Mos  
State   Zip   Salary   per  
6. Prior Employer
Company Name  
How Long Yrs   Mos    
7. Creditors/Major Credit Cards/Major Department Stores
  Name Addr or Acct Num Open/Closed Balance Mo Payment Date Closed
8. Previous automobile financed by
9. Bank Reference
Name Address Type
10. Spouse - Complete this section ONLY if spouse will also be contractually liable for repayment of applicant
is relying on the income of the spouse. Co-Applicants other than spouse must complete a separate application.
Name   Date of Birth     (mm-dd-yyyy)
Company    Supervisor  
Street   Phone  
City   How Long? Yrs   Mos  
State    Zip   Salary   per  
Name and address of nearest relative not in household
Name   Phone  
Street   Relationship  
State   Zip    
I (we) certify the above information to be true in every respect and that it correctly reflects my current financial condition. I (we) authorize the Creditor to make whatever credit inquiries it deems necessary in connection with this credit application or in the course of review or collection of any credit extended in reliance on the application including, without limitation, inquiries to any agency of government - federal, state, or local. I (we) authorize and instruct any person, governmental agency or consumer reporting agency to compile and furnish the Creditor any information it may have or obtain in response to such inquiries and agree that same shall remain the property of the Creditor whether or not credit is extended.
Have any of the undersigned filed bankruptcy or have any judgements, repossessions, garnishments or other legal proceedings filed against the undersigned in the last seven years?
If yes, please explain:  
Initials   Date   Initials   Date  
Free Bridge Auto Sales 1400 Richmond Road Charlottesville, VA 22911
Sales 434-296-0006 Service 434-979-2886