21st Century Motors



	Your Job Is Your Credit..... For More Information Call 207-839-9200

Welcome to the 21st Century Motors web site. We're a family based dealership run by two generations. We take care of our customers and treat them like family. Please join our family today.

First Name:

M.I.

Last Name:

Address:

City:

State:

Zip:

How Many Years?

Rent
Own

Monthly Rent/Mortgage:
$

Email Address:

No. of Dependents:

Home Phone:

Cell Phone:

Social Security No:

Date of Birth:

Previous Address:

City:

State

ZIP:

How Long:

Months
Years

Current Landlord or Mortgage Holder:

Address:

Phone:

Employer or Company:

How Long?

Months
Years

If Self-Employed, Nature of Business:

Business Address:

City:

State:

ZIP:

Business Phone:

Position:

Gross Monthly Income:
$

Net Monthly Income:
$

Source of other Income:
$

Amount:
$

Net Total Monthy Income:
$

Previous Employer:

Previous Employer Address:

Phone:

How Long?

Months
Years

If total length of all employment is less that 5 years list prior employer or occupation

Previous Employer:

Address:

How Long:

Months
Years

List 2 nearest relatives and one personal friend.

Nearest Relative (not living with you):

Phone:

Relationship:

Address:

City:

State:

ZIP:

Nearest Relative (not living with you):

Phone:

Relationship:

Address:

City:

State:

ZIP:

Personal Friend:

Address:

City:

State:

ZIP:

Phone:

Have you ever filed for Bankruptcy?

Yes
No

If Yes, Date:

Have you ever had a
Repossession?

What?
When?

All the information given on this application is true, correct and complete. We or our assignee is authorized to exchange credit information covering this application and any credit granted. As part of the credit investigation process, we or our assignee may request a consumer report or commercial credit report in connection with this application for credit or any update, renewal or extension thereof. Upon request, we or our assignee will tell you whether or not a consumer report or commercial credit report was obtained and the name and address of the consumer reporting agency. I agree that we or our assignee may retain this application whether or not credit is approved. For purposes of securing credit and preparing documents, the signers agree and warrant that the above statements are true and correct.

I certify that the above information is complete and accurate. I authorize an investigation of my credit and employment history and the release of information about my credit experience.

I Accept

21st Century Motors
468 Main St.
Gorham, ME 04038
207-839-9200