lJ ln Person LJ Mail/Fax PURCHASER'S STATEM~:

IMPORTA_NT NOTICE: Arizona is a "Community Property" slate. which generally means that all property, goods, satai:es;.~ debts ac:i~~ed. eame~ 0 •,;i~~l '
a~er mamage belong by law, lo the rnatital community. "Sole and $epatat& Property" is generally defined as these goods. property. i.. ~ome and ... eti,_ ""-~-
pnor to marriage or inherited alter marriage.
E_ilher spo_use indtiidually may manage the community p,o~rty or bind the community to the payment
of c»bt (generaiiy). The ~:,k m~~uire co!h s~t.:s~
sign ce1111n loan documents neceuary or thought nec1111ry 10 create a valid iian or security interest under applicable Anzooa 1~ - · "

COIIIIUNITY PROPERTY DEBT: "This application, unless oU>etwise mfk8tt below, is 10 be.c:oosidll'ecl as an appli~ion for c:edi~xte nded as a oa:;; =
marital community. based upon the creditworthiness of that community." 'Sf,P?IY all information requested on the apphcat:o:1.
SOLE AND SEPARATE PROPERTY: · .. .
0 This is an application tor individual credit as sole and separate debt, which wili be t)'aluated without ragaid to the ~sselS. 0,:71 8 ~r creo,i·:5~~:.;.;:5} _:_
applicant's spouse or the applicant's marital community. (The applicant should only list marital ~us a_nd ~a oii'ler ,nfo;~ali~, · :,hou.o-1oe 9'.".e.' ·
ir.: '-::,~:7·~:~
spouse (ii any) except 11ame and addr9ss. Applicant should also list 21ll deblS for which he/she is obligated oy s;gn;r.g !O pro,·,!Se ,o pay· an-- shou,c 2150 ··- · - ·
and separate assets and income .) ·
Dealer !Dale
t
I

Print Full Name wt ;,!I J,. c: Sr. Social Secuii:,Y No. ! n-,•e
_,c;.1 ,,f =.;~'"
V ,_.,: .,1

~se•s Full Name w: Ml .:r. oc ss Social Security No. I Date of Birth

i
No ol f"le:,end 0 ... t <:
Olher Name for Credit File Marital Status 0 MARRIED O UNMARRIED [J SEPARAT-ED; . ''-' · _,.. ..
i I

Horne Address C11y Stc:a Zlr'. / How Lc:.g a! Address

i
Mailing Address Cay ~ W' · ..
1.; ome_ei-
- .one N"
. v .

PreviOus Address swa Zl? Ho-., Long al Address

Previous Address Stale ZIP How Long al Address l'; s

Nearest Relative (not l1Ving with youj Address Reiationship /Phcne No.
I . I
Spouse's Nearest Relative 1Mdress IRaiatior:ship !Phcr.e NO.
i /
· • Allfllony, ~ support, or aeparete ~ incomi nNCI not b e ~ If~ de_r.:t wlSh !cha-~ it =r.s<,dmc as a basis :er rapayin9 tlii£ c:.!!;:;
Alimony, child support, separate maintenance receiwd under: CO'Jrt c:der _ _ ~nl!er. agraemsnt _ _ era! understanding
Present Employer (type of business if sell empk>y8'!) IMmrary ?ay G:aca / Discharge Date
Addiess Ci!y
i
Stale
9 Business Phone
Position Ii~yer lD No. ·
Spouse's Employer (name and address) !?hone !How Lone Yr;. ~ -i Gmss income
! - I Mon!h!vl $
Source ol Othel' Income (See above)
2
!Other Ir.come ~
Previous Employer (name-and address)
! $
\Positior. !How Lene Yr... \TOTAL INCOME
I \ - ;Jo

Name of Your Bank Checking Account Ne. iAverage Balancs

Sraoch Neme and Address Savings ~lll:t Ne. !A\lerage Sa!sr.ce
i
DEBT AND CP.elliT AE~""ES \ ~LA~CE l i ~l.3!,
I OUE {l~ 5!.N'fi I ~ ?~'l'~ i
Sank Cred1l card No !Credit Limit
01 - Rent Landlord/Mortgage Holder
02-0wr,
Car Vear Mw

Banl(s

Finance Co.lCfedit Union

Depanment Stores

Credit Cards

Drivers License Numb9r _ _ _ _ _ _ _ _ _ __

Have You Had Any :)I :he F-:licwing?

1
Repossession 0 YES O N0

Banlcrupicy C YES □ rm X
Garmshmem 0 YES ONO

X
• I

CJ ln Person LJ Mail/Fax PURCHASER 'S STATE~~:

acquired . earned c ; cc::.:,e::
which generally means that all property, QCOds, salarias, ~d debts
IMPORTA_N T NOTICE: Arizona is a " Commun ity Property" slate. is generally defined as these gccds. p:o perty. ir.com e ar.d cteti:; '"c:: _
mar,1a1commun ity. "Sole and Separats Pn:iperty"
alter mamage belong by l_a w. to lhemarriage .
prior to marriage or inherited alter
or bind the communi ty to the payment o f ~ I (~neraii y). The
8.s:,~ m~;-1u ore ocih 3r'•~ s,
E_itl'ler spouse indNldua/Jy may manage the commun ity property applicabl e A;izcna i2W. '
y 10 creale a Y8lid iian or security interest t.'tld!r
sign ce1111n loan documents neceuary or thought necesaar :
below, is to be.COllliclefed as an application for c.edi~xt ended as c de::;
COMMUNITY PROPER TY DEBT: "This application, unless Olhetwise m ~ all informati on requested on the app!icalio :..
commun ity." ~pply
marital commun ity. based upon the creditwo nhiness of that
SOLE ANO SEPARA TE PROPER TY: '.r.::12:os :
wiil be 8)'p]uateo withoul regard to !ha assets. ir.ccma or cr8ditw:::r
0 This is an applicati on tor individua l credit as sole and separate debt. which should only tis! marital Slalus and no other informat,o;: 3ho u;o be g:vec, re,;;;;;r::,~;
[The applicant
to pay. an d sh ouid also ::s'. ~ ·
applican t's spouse or the applicant 's marilal communi ty.
list all d9b!S fer which h8/she is obligated by signir.g !o prom;se
spouse (if any) excep1riame and address. Applican t should also
·
and separate assets and income.)
Dealer
, Date

Prinl Fu!! Neme ~ t .!I J!. a Sr.,Soc~ Sec!..liiiy Nu . foate of 3 :r'.~

Mt Jr. "'s,. Social Security Ne. / Dal e o f Birth
Cc'Spouse's Full Name i
Other Name for Credit File Marital Status 0 MARRiED C UNMARRIED 0
SEPARATED No . o f De;:iende r:ls j
I
Stlla ZI?. ! How L~g c! Addrsss
Home Address i
Mailing Address Cil't SW Z:? 1c;. .ome F-t.one ,,· ,c.
SW,, ZIF i How Lor.g 21 Address
Prevk)us Address

Previous Address
Sla!C ZIP IHow Lo,"1g 21 Address Y;s

'
} Reia\iOiiSh!p . j Phcne No.
Nearest Relative (not living with you) !Address I
! !
!Reiationship lc~--e No
I'
JAddress
ll\.i l f

· Spouse's N9i!l'est Relative· I !

. chllc! support, or...,.,.. ._ maintlnlnce income Med no! bs ~ i_ t ~ de i=t ~ IQ ~~ it ~1!5' ~ es B bilSi3 ~ :apa¥ir.g t'iie .:;;!!;:;
·•~ ce-..:i1 ~oar _ written agraemsnt _ _ c:-ra! :.m:iers tsnd;ng _ __
Alimony, child support, separate mair.tena nce recei11ed u.'lder:

Present Employe r (type of t:iusiness if self s,mplcy--od)

IMilitary ?ay G~2da f Discharg e Daie

Add;ess
iBusiness Phor.e
!Ta:;payer IDNo . . ;.;o--f-Grcs s-!;;come
Posrtior. J!Mc:thi 1
I HO\'! Long
Yr;,, Mo. Gross Income
Spouse's Employe r (n.;me and address) I F'hone
Month~·}
O!hs,r l r.cor.-:e ~
Source o! 0th~ Income 2 (See above) $
,,,__.,;_ ;.so ! TOTA L INCOME
Previous Employe r (name ano address) pt"""
Name of Your Bank
iC!-.eckir:-g Account No. J Average a alancs

1Savincs Ace;)~: Ne. !Ave-age 9aisr~ s-

Branch Name and Address i ~
i
l D~~!..l•Utl.. , l:lAL.Ai-!CE A~{],,
OEST ANO CF.EDiT A : ~ S - MllOIJi'f: ' f OUE {!F ~ '!1 ~ ?~"~i

Sank Credit card No ICredit Limit

O 1 - Rent Landlord /Mortgag e Helder
n
Car

Banks
Finance Co./Cred i! Union

Depanment S!Ores

Credit Cards
n.nAl !~
Of- O B :AiNl NG CRED,-
!/WE GIVE t ~E ABOVE iNFO!<M A!lON :'OR TliE ? URPOSE
AT!QN CONCER N ,:-;:
AUT!!ORIZE DEALER OR.:3Ar,~./L~N DER 0 Ou: A ,~ i NFORM
7
-
Drivers License Number - - - - - - - ---::--- - - . THE B t-.N;< TO CQ~~t::
ST:iTE~i tNTS MADE HER.EE,,:. :N ADD!:':Q \;, ~ AU:"SQ~ tZE
Hal/8 You Hao Any ~ ,neP-.,iicwing? AT ;..~y TELEPi?ON~

G YES O NO'
Repossession
ONO
X
8ankrupl cy DYES

0 YES ONO
Garnishm ent
X