ONLINE CREDIT APP | Triumph Waukesha

First name

Middle name

Last name

Address

City

State

ZIP Code

Years at Address

Phone

Work Phone

Email

Social Security Number

Date of Birth

Own

Rent

Live with Others

Mortgage Holder Name or Landlord Name or None

Monthly Payment

Previous Address If Less Than 5 Years

Previous City

Previous State

Previous ZIP Code

Years at Previous Address

Current Employer

Employer Address

Employer Phone

Gross Income per Month

Occupation

Time at Employer

Other Income per Month

Other Income Source

Previous Employer (if less than 3 years at current employer)

Previous Employer Address

Previous Employer Phone

Maritial Status

Married

Seperated

Single/Divorced/Widowed

Are you a US Citizen or permanent resident?

Yes

No

Have you ever filed for bankruptcy?

Yes

No

Have you ever had property repossessed or foreclosed in the last 7 years?

Yes

No

By submitting this application you are certifying that all information on this application is complete and accurate. You give your permission for any financial institution which will review this credit application, to investigate your credit and employment history, and to answer questions about credit experience with you. You understand and authorize Dealer and Integrated Lending Technologies, LLC to share my credit information only with affiliated lenders for the sole purpose of obtaining the loan I have requested. You understand that by submitting this application, You are authorizing the lender to perform a credit check on you. FAIR CREDIT REPORTING ACT DISCLOSURE: This application for credit will be submitted to Lending Institutions deemed appropriate by the Submitting Dealer for consideration as to whether it meets credit requirements.

If I am a married resident of Wisconsin and applying for credit separately from my spouse, I certify that the credit being applied for, if granted,

will be incurred or obtained in the interest of the marriage or family. This statement is made in accordance with Wis. Stat. sec. 766.55(1).

Triumph Waukesha Online Credit application