Gamblin Motors Secure Credit Application Please feel free to phone us at: (888) 895-2244 if you have any questions or would prefer to fax your credit application to us. Please Note: All fields shown in bold red are required to submit this form. Apply Online: Individual or Joint Credit: Individual Joint Your Information Full Name: Address: City: State: Zip: Phone: E-Mail: How Long at This Address? SSN: Date of Birth: Driver's License Number: Issuing State: Co-Applicant Spouse Info Full Name: Date of Birth: SSN: Employment Information Current Employer: Monthly Income: Work Phone Number: Other Income: (List Amount and Source) Residence Information Do You Rent or Own? Own Rent Mortgage Holder or Landlord Info: Rent or Mortgage Mo. Amount: Banking Reference/Info Name of Bank: Account Number: Branch or Address: Type of Account(s): Checking Savings Checking and Savings Have You Ever Filed for Bankruptcy? Yes No Additional Information: Please Include any Additional Information You Feel Would be Relevant to Obtaining Financing Here:

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