Credit Application | Herb's Quality Used Cars, Trucks and Service

                
            Credit Application
                
Please fill out the form completely. Incomplete forms will result in delayed processing of your credit application. If you have any questions or prefer to fill out a credit application in person or by phone please stop by Herb's Auto or call 304-258-1312.
Applicant Information

                            First Name
                            
                            Last Name
                            
Date of Birth

                            Month
                            
                            Day
                            
                            Year
                            
                            Social Security Number
                            
Current Address

                            Street Address
                            
                            City
                            
                            State
                            
                            Zip
                            
                            Cell Phone Number
                            
                            Home Number
                            
                            Email
                            
                            Housing Status
                            
Own

Buying

Rent

Living with Family

Mobile Home

                            How Long?
                            
Employment Information

                            Current Employer
                            
                            Employer Address
                            
                            City
                            
                            State
                            
                            Zip
                            
                            Employer Phone Number
                            
                            Position
                            
                            Gross Montly Salary
                            
                            Employed for How Long?
                            
Co-Applicant Information
Please supply the following information if submitting your application with a co-applicant.

                            Co-Applicant First Name
                            
                            Co-Applicant Last Name
                            
Co-Applicant Date of Birth

                            Month
                            
                            Day
                            
                            Year
                            
                            Co-Applicant SSN
                            
                            Co-Applicant Phone Number
                            
Co-Applicant Address

                            Street Address
                            
                            City
                            
                            State
                            
                            Zip
                            
                            Co-Applicant Housing Status
                            
Own

Buying

Rent

Living with Family

Mobile Home

                            How Long
                            
Co-Applicant Employment Information

                            Co-Applicant Employer
                            
Co-Applicant Employer Address

                            Street Address
                            
                            City
                            
                            State
                            
                            Zip
                            
                            Co-Applicant Employer Phone Number
                            
                            Co-Applicant Position
                            
                            Co-Applicant Gross Montly Salary
                            
                            Co-Applicant Employed for How Long?