Blake Fulenwider CJDWebApplyOne

Customer Info
Vehicle Info
Financing Info

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Copies applicant's phone, address, city, state and zip over to the co-applicant

Relationship Code

Relationship

First Name

Middle Initial

Last Name

E-mail Address

Address

City

State

ZIP

Time at Address

Years Months

Previous Address

Previous City

Previous State

Previous ZIP

Previous Time at Address

Years Months

Residence Type

Home Phone #

Cellular Phone #

SSN

DOB(MM/DD/YYYY)

Rent/Mortgage

Education Level

Employment Title

Employer Name

Employer Phone #

Time at Job

Years Months

Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Gross Monthly Income

Income Interval

Other Income Source

Other Income Amount

Other Income Interval

Previous Employer Name

Previous Employment Title

Previous Employer Phone #

Previous Time at Job

Years Months

Salesperson

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Trade Vehicle?

No Yes

New or Used?

New Used

Vehicle Year

Vehicle Make

Vehicle Model

Vehicle Stock #

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Buy or Lease

Buy Lease

Cash Down

Financed Amount

Term

Total Monthly Payment (Est)

Comments

Characters Remaining : 200

RouteOne Disclosure Wisconsin Resident
For the Applicant, please indicate: Marital Status:
If married or separated: Non-applicant Spouse's First Name: Last Name:
Non-applicant Spouse's Address: City: State: ZIP:
Notice: No provision of a marital property agreement, a unilateral statement under s. 766.59 or a court decree under s. 766.70 adversely affects the interest of a creditor unless the creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred.

I certify that I have read and received the above state disclosures.

RouteOne Disclosure Wisconsin Resident
For the Co-Applicant, please indicate: Marital Status:
If married or separated: Non-applicant Spouse's First Name: Last Name:
Non-applicant Spouse's Address: City: State: ZIP:
Notice: No provision of a marital property agreement, a unilateral statement under s. 766.59 or a court decree under s. 766.70 adversely affects the interest of a creditor unless the creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred.

I certify that I have read and received the above state disclosures.

By clicking this box, I agree that this credit application is an electronic credit application submitted using electronic means and such means signifies my intent to submit this credit application to Blake Fulenwider CJD to the same extent as if I had executed this credit application using my written signature.

By clicking this box, I confirm that the co-applicant agrees that this credit application is an electronic credit application submitted using electronic means and such means signifies the co-applicant�s intent to submit this credit application to Blake Fulenwider CJD to the same extent as if the co-applicant had executed this credit application using the co-applicant�s written signature.

By clicking the 'Apply for Financing' button, I agree that you, your affiliates, agents and service providers may monitor and record telephone calls regarding my account to assure the quality of your service or for other reasons. I also expressly consent and agree to you, your affiliates, agents and service providers using written, electronic or verbal means to contact me as the law allows. This consent includes, but is not limited to, contact by manual calling methods, prerecorded or artificial voice messages, text messages, emails and/or automatic telephone dialing systems. I agree you, your affiliates, agents and service providers may do so using any e-mail address or any telephone number I provide, now or in the future, including a number for a cellular phone or other wireless device, regardless of whether I incur charges as a result.

By clicking the 'Apply for Financing' button, I authorize Blake Fulenwider CJD and any finance company, bank or other financial institution to which the dealer submits my application ("you") to investigate my credit and employment history, obtain credit reports, and release information about your credit experience with me as the law permits. If an account is created, I authorize you to obtain credit reports for the purpose of reviewing or taking collection action on the account or for other legitimate purposes associated with the account. I certify that I have read and agree to the terms of this application and that the information in it is complete and true.

By clicking the 'Apply for Financing' button, I agree, and I confirm that the co-applicant agrees, that you, your affiliates, agents and service providers may monitor and record telephone calls regarding our account to assure the quality of your service or for other reasons. I also expressly consent and agree, and I confirm that the co-applicant consents and agrees, to you, your affiliates, agents and service providers using written, electronic or verbal means to contact us as the law allows. This consent includes, but is not limited to, contact by manual calling methods, prerecorded or artificial voice messages, text messages, emails and/or automatic telephone dialing systems. I agree, and I confirm that the co-applicant agrees, you, your affiliates, agents and service providers may do so using any e-mail address or any telephone number we provide, now or in the future, including a number for a cellular phone or other wireless device, regardless of whether we incur charges as a result.

By clicking the 'Apply for Financing' button, I authorize, and I confirm that the co-applicant authorizes, Blake Fulenwider CJD and any finance company, bank or other financial institution to which the dealer submits our application ("you") to investigate our credit and employment history, obtain credit reports, and release information about your credit experience with us as the law permits. If an account is created, I authorize, and I confirm that the co-applicant authorizes, you to obtain credit reports for the purpose of reviewing or taking collection action on the account or for other legitimate purposes associated with the account. I certify that the co-applicant and I have read and agree to the terms of this application and that the information in it is complete and true.