Ford Credit Application – Fill Out and Use

CHECK ONE APPLICABLE BOX (PRIMARY APPLICANT AND JOINT APPLICANTS MUST COMPLETE SEPARATE FORMS):

If Joint Applicant, Relationship to Applicant:

Primary Applicant:

Joint Applicant:

Application is for joint credit with primary applicant or a guarantor.

S - Married

P - Parent

Primary applicant is relying on me for income for alimony, child support, or separate

maintenance or on my income or assets as the basis for repayment of the credit requested.

O - Other

Physical Address (Number, Street, Apartment)

City

State

Zip Code

Billing Address (Number, Street, Apartment, P.O. Box)

City

State

Zip Code

County

Phone in

1

Yes

Phone Number

1

Own Home

3

Living with

5

Own/Buying

Lived There

Applicant’s

2

No

Area Code

Outright

Relatives

Mobile Home

Home?

(

)

2

Buying Home

4

Leasing/Renting

Yrs.

Mos.

Cell Phone Number

Other Phone Number

Email Address - Personal

Email Address - Business

Area Code

Area Code

(

)

(

)

Name and Address of Landlord or Mortgage Holder

Phone Number of Landlord or Mortgage Holder

Rent or Mtge. Pmt.

Area Code

$

(

)

Previous Address (Street, City, State and Zip Code) (If less than 2 years at present address)

Lived There

Yrs.

Level of Education

1

4-Year College Grad.

2

2-Year College Grad.

3

Special Training

4

Some College

High School Grad.? 5

Yes

6

No

(Age Under 27 Only)

Current Employer Name

Current Employer Address

Applicant’s Occupation (If military, state rank)

Work Phone Number

Gross Monthly Salary

Time on Job

Area Code (

)

$

Yrs.

Mos.

*Alimony, child support or separate maintenance income need not be revealed if

*Source of other income

Other Income

I do not wish to have it considered as a basis for repaying this obligation.

$

Previous Employer’s Name (If less than 5 years at current employer)

City/State

Name of Bank

1

Checking & Savings

3

Savings Only

2

Checking Only

4

No Account

Have I Ever Had a Car or Other

No

Month

Year

Have I Ever

No

Month

Year

Merchandise Repossessed?

Yes

If Yes, When?

Filed Bankruptcy?

Yes

If Yes, When?

Creditor’s Name and City/State

Date

Monthly

Unpaid

Creditor’s Name and City/State

Date

Monthly

Unpaid

Opened

Pmt. Amount

Balance

Opened

Pmt. Amount

Balance

(Current/Previous Cars Financed by or Leased through)

(Other Credit)

(1)

(3)

(2)

(4)

Name and Address of Applicant’s Nearest Relatives/Friends Not in Household

Phone No.

Relationship

(1)

Area Code (

)

(2)

Phone No.

Relationship

Area Code (

)

(3)

Phone No.

Relationship

Area Code (

)

(4)

Phone No.

Relationship

Area Code (

)

Applicant Signature:

Date:

I intend to apply for joint credit.

initial here

NON-APPLICANT SPOUSE INFORMATION

Jr.

Married

Sr.

RESIDENTS

Last Name

First Name

Middle Name

Unmarried

Separated

Mailing Address

City

State

Zip Code

MARITAL PROPERTY AGREEMENT NOTICE

No provisions of any marital property agreement, unilateral statement under Section 766.59 Wisconsin Statutes Or

WISCONSIN

Court Decree under Section 766.70 Wisconsin Statutes adversely affects the interest of Creditor unless Creditor,

prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has

actual knowledge of the adverse provision when the obligation to Creditor is incurred.

STATEMENT OF MARITAL PURPOSE

I have applied for credit from

For the purpose of purchasing

is

(Dealer)

(Description of Vehicle)

This Obligation (check only one)

Being incurred in the interest of my marriage or family.

is not

Signature:

FCNA 7141-G/CM3 Dec 08 (Previous editions may NOT be used)

FORD CREDIT

SIDE A