Full Name : 

Social Security No. : 

Date of Birth : 

Email Address : 

Phone Number : 

Address : 

City : 

State : 

Zip Code : 

Housing Status : 

Monthly Housing   
 Payment : 

Present Employer : 

Length of    
Employment : 

Current Position : 

Monthly Income : 

Other Income : 

Vehicle Desired : 

Desired Year : 

Desired Make : 

Down Payment : 

If Trade-In : 

Describe Trade In : 

Year : 

Make : 

Model : 

Mileage : 

Balance Owed : 

   By submitting this application, I certify that all information herein is true and complete. I authorize Budget Car
   Sales of Dallas to retain this application, to rely on the foregoing, to check and verify my credit, employment and
   salary history, and to secure follow-up reports concerning my creditworthiness.

Yes, I give you authorization No, I do not give you authorization