Online Credit Application - Brian's Auto Sales

Download to Print

Print out your application and fax in at 706-625-1854 or complete online form below

Credit Application

Name *

First

Last

Phone Number *

Date of Birth *

Address *

Address (2)

City *

State *

Zip Code *

Do you Rent or Own? *

Rent
Own

How long have you lived there? *

How Much is Rent/Mortgage? *

Full Name & Phone Number of 2 Nearest Living Relatives *

Income Information *

Employed
Fixed Income
No Income

Income Amount (Per check, after taxes) *

Source of Income / Name of Employer *

Employer Address *

Employer Phone Number *

Date you were hired *

How often are you paid?

Full Name & Phone Number of 2 Credit References (not family) *

Does anyone 16 years or older live in this home besides you? Please list names and ages.

Have you ever filed for Bankruptcy (Chapter 13 or 7)? *

Yes, Chapter 7
Yes, Chapter 13
No

If yes, when did you file and when were you released?

Have you ever applied for credit with Brian's Auto Sales? (If yes, when?) *

Have you ever purchased a car with Brian's Auto Sales? (If yes, what and when?) *

How Did You Hear About Us? *

Referred
Online – Google or Facebook
Driving Past

Who referred you (if referred)?

Terms & Conditions *

I have read and agree to the following Terms & Conditions.

I certify the information below to be complete and realize a representative from Brian’s Auto Sales will contact me for my Social Security /Liscense number and Birthday. I certify that the above information is complete and correct. In addition, I authorize Brian’s Auto Sales, Inc. to contact me in writing, by e-mail, or using pre recorded voice message, text messages, automatic dialing systems, to the extent not prohibited by law. I also agree that Brian’s Auto Sales may contact me at any address or telephone number I provide, even if it is a mobile phone number and I am charged for it by my service provider. Brian’s Auto Sales may monitor or record my dealings with them, including telephone conversations. I agree to the terms of Brian’s Auto Sales, Inc. Privacy Policy, and know I may Opt out of e-mail at any time. I authorize and consent to Brian’s Auto Sales, Inc. , investigating my credit, including obtaining information from a credit reporting agency or agencies; contacting me electronically (i.e. email, text, chat); calling me, including my cell phone and doing so through the use of technology such as a dialer; and recording any calls with me for quality assurance purposes. Thank you for trusting in Brian’s Auto Sales to meet your vehicle and financing needs!