BINGHAM SCION

895 W SHAW
CLOVIS, CA 93612
Phone: 559-291-5544
Fax: 559-291-0714

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This secure form will start the credit verification process. Fields marked * are required.

Applicant Information

First Name *

Middle Initial

Last Name *

Suffix

Date of Birth *

Email *

Social Security Number *

Address *

City *

State *

ZIP *

Home Phone Number *

Housing Information

Length of Residence

Housing Status

Mortgage/Rent Amount

Landlord or Mortgage Holder

Previous Address

Previous City

Previous State

Previous ZIP

Previous Length of Residence

Previous Rent or Mortgage Amount

Employment Information

Employer *

Occupation *

Employer Phone *

Gross Monthly Income *

Time Employed

Previous Employer

Previous Occupation

Previous Employer's Phone

Previous Gross Monthly Income

Previous Time Employed

Your Current Auto Loan

Make/Model

Co-Applicant Information

Co-Signer First Name

Co-Applicant Middle Initial

Suffix

Co-Applicant Last Name

Co-Applicant Social Security Number

Signature & Privacy Statement

Signature *

Date *

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By submitting this credit application, I verify that the information provided is complete and accurate to the best of my knowledge. I further authorize an investigation of my credit and employment history. I also accept the terms of the Privacy Policy.

BINGHAM SCION • 559-291-5544

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