ADAMS AUTO SALES FINANCE APPLICATION

Name		Date of Birth
Physical Residental Address (P.O. Box is not acceptable)		Phone Number
City	State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands, U.S. Virginia Washington West Virginia Wisconsin Wyoming ANY		Zip	Social Security #
How long at present address?     Years Months			Dependents	Driver's License
Home? Rent Own			Monthly	To Whom?
Previous Address		How long? Years Months
Employer		How Long? Years Months
Address		Phone number
Occupation		Net Compensation (Monthly)
Former Employer		How Long? Years Months
Address
Nearest relative not living with you		Address
Note: You are not required to list income from alimony, child support or separate maintenance payments, UNLESS you wish to rely on such income. However, if any of the additional income shown is from such a source, what is the amount? (Monthly)
Other income	Source
I AUTHORIZE the making of whatever credit inquiries are deemed necessary to connection with my credit application or in the course of review or collection of any credit extended in reliance on teh application. I authorize and instruct any person or consumer reporting agency to complete and furnish any information it may have or obtain in response to such credit inquiries and agree that same shall remain your property whether not credit is extended. I have read the foregoing application and the statements made in it are true and correct.
Yes No	Date