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ALLSTATE AUTO SALES LOAN APPLICATION

Loan Information

Desired Loan Amount:

Desired Monthly Payment:

Personal Information

First Name:*

Middle Initial:

Last Name:*

SSN*

Birthday*

Drivers Lic. #:*

Drivers Lic. State:*

Driver Lic. Exp. Date:*

Address:*

City:*

State:*

Zip code*

Daytime Phone:*

Evening Phone:

Email Address*

Mortgage/Rent Payment:*

Time at Residence:*

If you have lived at your current residence less than 1 year, please enter your prior address:

Which accounts are in your name:*

Utilities

Savings

Checking

Phone

Employment

Employer Name:

Employer Address:

Employer City:

Employer State:

Employer Zip:

Employer Phone:

Occupation:

Time On Job:*

Monthly Income:*

Other Income:

I accept these terms.*

I agree that by submitting this application, I authorize and give this dealership, as well as any potential financing source this dealership presents this application to, my consent to obtain my credit report from any credit reporting agency used to complete an investigation of my credit. By submitting this application, I certify that all information herein is true and complete. I agree I am providing this information to the dealer identified in this application and acknowledge that my information may be shared pursuant to the dealer's privacy policy, if applicable. I hereby authorize this dealer, and any financial institution engaged as a service provider by this dealer, to retain this application and to check and verify my credit, employment and salary history. By submitting this application, I authorize this dealer and/or financial institutions, as they consider necessary and appropriate, to obtain consumer credit reports on me periodically and to gather employment history in order to determine financing eligibility.

Vehicle Information

Desire Vehicle

Down Payment

Down Payment Amount:*

Trade-In Details (Optional)

Trade-in Make:

Trade-in Model:

Trade-in Year:

Trade-in Mileage:

Additional Comments

By submitting this application, I certify that all information herein is true and complete. I agree I am providing this information to the dealer identified in this application and acknowledge that my information may be shared pursuant to the dealer’s privacy policy, if applicable. I hereby authorize this dealer, and any financial institution engaged as a service provider by this dealer, to retain this application and to check and verify my credit, employment and salary history. By submitting this application, I acknowledge I am authorizing this dealer to check my credit.