Credit Application

For your protection this credit application is secured with 256-bit SSL encryption.
Verify that the browser's address bar displays the secure page lock icon.

* Required Field

Application Type *

Personal Information

Applicant:

First Name *

Middle Name

Last Name *

Email Address *

Home Phone *

Work Phone *

Cell Phone

Social Security #

Date of Birth *

Driver's License #

Driver's License Exp. Date

Driver's License Issued In

When should we contact you?

Co-Applicant

First Name *

Middle Name

Last Name *

Email Address *

Home Phone *

Work Phone *

Cell Phone

Social Security #

Date of Birth *

Driver's License #

Driver's License Exp. Date

Driver's License Issued In

Employment Information

Applicant:

Employment Status *

Current Employer *

Title / Occupation *

Employer Address *

Employer Address Line 2

City *

State*

Zip Code *

Business Phone *

Time at Employer - Years *

Time at Employer - Months *

Gross Monthly Income *

Previous Employer

Title / Occupation

Time at Employer - Years

Time at Employer - Months

Co-Applicant

Employment Status

Current Employer *

Title / Occupation *

Employer Address *

Employer Address Line 2

City *

State*

Zip Code *

Business Phone *

Time at Employer - Years *

Time at Employer - Months *

Gross Monthly Income *

Previous Employer

Title / Occupation

Time at Employer - Years

Time at Employer - Months

Residential Information

Applicant:

Current Address *

Current Address Line 2

City *

State*

Zip Code *

Status *

Mortgage Payment / Rent *

Time at Residence - Years *

Time at Residence - Months *

Previous Address

Previous Address Line 2

City

State

Zip Code

Status

Mortgage Payment / Rent

Time at Residence - Years

Time at Residence - Months

Co-Applicant

Current Address *

Current Address Line 2

City *

State*

Zip Code *

Status *

Mortgage Payment / Rent *

Time at Residence - Years *

Time at Residence - Months *

Previous Address

Previous Address Line 2

City

State

Zip Code

Status

Mortgage Payment / Rent

Time at Residence - Years

Time at Residence - Months

Financial Information

Applicant:

Mortgage Balance

Mortgage Lender

Monthly Payment

Name of Bank

Account Type(s)

Name of Bank

Account Type(s)

Other Income (monthly)

Source

Other Income (monthly)

Source

Other Income (monthly)

Source

Desired Vehicle

Filter Desired Vehicle

Year:

Make:

Model:

Reset Filter

Desired Vehicle

Desired Loan

Vehicle Price

Down Payment

Trade-In Value

Sales Tax

Interest Rate

Loan Term (Months)

Amount Financed

Monthly Payment

I certify that the information provided by me is correct.
I certify that I am eighteen years of age or older.

I also understand that you will be checking with credit reporting agencies.
I authorize an investigation of my credit and employment history and the release of information about my credit experience.

Quick Contact

Dealership Info

Contact Us

Main Phone:

724-287-2260

Fax:

724-285-9779

Email:

sales@wallacefamilymotors.com

Business Hours

Mon:	9:00AM to 8:00PM
Tue:	9:00AM to 6:00PM
Wed:	9:00AM to 6:00PM
Thu:	9:00AM to 6:00PM
Fri:	9:00AM to 6:00PM
Sat:	By Appointment
Sun:	Closed

Location

1764 N Main St Ext
Butler, PA 16001