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Please fill out the form below. The fields with an * are required.

Do you have a co-applicant? Yes No
     
Have you changed residency in the last 3 years? Yes No
     
Have you changed employers in the last 3 years? Yes No
 
 
Personal Information
     
First Name: *
Last Name: *
Social Security No. *
Date of Birth (MM/DD/YYYY) *
Phone: *
Alt. Phone:  
Fax:  
Email: *
Address: *
City: *
State: *
Zip: *
Time living at current address: *
Years   Months
 
Do you have a valid drivers licencse? Yes No
 
 
Employment Information
     
Current Job:    
Time at current job: *
Years   Months
 
Title: *
Company: *
Work Phone: *
Gross Income: *$
Previous Job:    
Time at previous job:  
Years   Months
 
Title:  
Company:  
Work Phone:  
Gross Income: $
 
 
Credit Infomation:
 
Have you ever had a vehicle repossessed? * Yes No
     
Have you ever declared bankruptcy? * Yes No
     
Do you have a checking account? * Yes No
     
Do you have a savings account? * Yes No
     
Your current home is: *
Monthly payment: $
Name of landlord or mortgage holder:  
Phone # of landlord or mortgage holder  
 
 
Final Information
 
Amount you have for a down payment: $

Information on the vehicle that would be used for a trade-in:
     
Best time of day to contact you:  
     
Additional questions or comments:
 
 
     
Store Hours
Mon-Thu 9-8
Fri 9-6
Sat 10-4
Sun 11-4
 
 
Budget Automart
711 E. Miller Rd.
Lansing, MI 48911
517-272-4400
Fax 517-272-4404