Credit Application |

Application For Credit Please complete all areas. Items marked with * must be completed Disclosure and Consent Statement
Personal Details
First Name	*
Last Name	*
Address Info
Address
City
State
Postcode
Home phone	*
Mobile phone
E-mail address
Time in the area	Years Months
Time at current Address	Years Months
Rent
Mortgage
Employment Details
Employer
Time at Current Employment	Years Months
Income	Monthly
Any Additional Income

Co-Applicant Details
Name
Address Info
Address
city
State
Postcode
Home phone
Mobile phone
E-mail address
Time at current Address	Years Months
Rent
Mortgage
Co-Applicant Employment Details
Employer
Time at Current Employment	Years Months
Income	Monthly
Any Additional Income

Submitting your Application

Thank you for taking the time to complete
this form. Before submitting it, please refer below.

	* Yes, I/we hereby agree that by completing and submitting this application, I have read the Privacy Statement.
	* Yes, I/we, the aforementioned applicant(s) hereby declare that the several statements made in this application are true and correct in every particular.

You may wish to print the completed
application form::
- for your own records before submitting it; or
- if you prefer to send it to us by mail or fax.

Sole Savers Auto
806 N Riverside
Medford, OR 97501

telephone: 541-772-8602
facsimile: 541-772-8598