Call Steve Tenwick at (702) 336-7771 or complete this form. If you are shopping for a vehicle, we want to help you! ALL INFORMATION IS KEPT CONFIDENTIAL AND USED SOLELY FOR THE PURPOSE OF OBTAINING AN AUTOLOAN First Name Last Name Date of Birth Social Security - - Drivers License Number Home Phone - - Cell Phone - - eMail Address Current Address City State Please Select Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Zip Housing Situation: Please Select Own Outright Pay Mortgage Rent Live with Relatives Other How Long at Residence? How Much do you Pay in Rent or Mortgage? Previous Address (If less than 2 years at current address) City State Please Select Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Zip Employment Employer Name Work Phone - - Job Title / Rank Gross Monthly Income How long on the job? Previous Employer (If less than 5 years at current job) How long at previous job? Do you have a Second Income? Please Select Yes No Amount of Second Income Source of Second Income Interest What Type of Vehicle are you interested in? Down Payment Amount Desired Payments Trade Information: Do you have a vehicle to trade? Please Select Yes No If so, What type of vehicle (Year / Make) VIN of your trade Miles on Trade How much do you owe on your trade? I authorize this website and its affiliates to check my credit    Yes    No