High Country Credit

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Name:

Address:

City:

State:

Zip:

Email
Address:

Home Phone:

Work Phone:

ext.

Fax:

Date Of Birth:

Year:

Social Security Number:

Do you own or rent?

Are you self employeed?

Current Employer:

Job Title: Time On Job:

Monthly Income: (please enter whole dollar amt.)

Do you have a valid drivers license?

Have you ever filed for bankruptcy?

If so, what year? Has it been discharged? If so, what year?

Do you have a current paystub?

How would you describe your credit?

Please tell us about the type of vehicle that you are most interested in:
(check all that apply)

Comments:

Car

Truck

SUV

Mini-Van

If someone else is applying with you please complete
Co-Applicant information after you have submitted this form.

Click here for CO-APPLICANT FORM

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