* I am applying for: Individual credit  Joint credit-Spouse  Joint credit-Non spouse

Vehicle loan     Amount requested:

Applicant

 * First name:   middle int.

 * Last name:

 * Social security #:

 * Drivers license #:

 * Date of birth:(MM/DD/YR)

 * Home phone: ()    Work phone: ()

   E-mail address:

 * Present street address:

 * City:, *State:   *Zip:

 * How long: Yrs. Mos.   own   rent   live w/parent   other

 * Marital status:  Married   Separated    Unmarried (incl. single, divorced, widowed)

 * Number of dependents

Employment and Income Information

 * Employer (R-retired, H-homemaker, S-student, N-unemployed, F-self-employed (list business name also))

  Address:

  City: ,     State:    Zip:

  Position:    How long: Yrs.  Mos.

 * Monthly gross salary: (or net monthly income for self-employed); if no income, enter "0".

   Monthly amount of other income:    Source:

   Alimony, child support, or separate maintenance income needs to be listed only if you wish such income to be            considered in evaluating this application.

Reference

 * Do you have a checking account?  Yes   No

 * Do you have a savings account?  Yes   No

 * Name of nearest relative / friend not living with you:   

 * Phone#: ()

 * Address:

 * City: ,   *State:    *Zip:

Debts and Obligations

                                                                Yes   No            Total monthly payment

 * Rent/mortgage (including tax & ins.)                        

  Credit Union/bank loan                                            

  Visa/MasterCard                                                     

  Department store                                                     

  Travel/oil company                                                   

  Other                                                                       

  Will you be trading in a vehicle?                        

  If Yes,   Loan balance:  Payment amount:

  Have you obtained credit under any other name (s)?    Yes    No

  If so, list name (s) under which credit has been received other than listed above.

Joint Applicant

 * First name:   middle int.

 * Last name:

 * Social security #:

* Drivers license #:

 * Date of birth:(MM/DD/YR)

 * Home phone: ()    Work phone: ()

   E-mail address:

 * Present street address:

 * City:, * State:   * Zip:

 * How long: Yrs. Mos.   own   rent   live w/parent   other

 * Marital status:  Married   Separated    Unmarried (incl. single, divorced, widowed)

 * Number of dependents

Joint Applicant's Employment and Income Information

 * Employer (R-retired, H-homemaker, S-student, N-unemployed, F-self-employed (list business name also))

  Address:

  City: ,     State:    Zip:

  Position:    How long: Yrs.  Mos.

 * Monthly gross salary: (or net monthly income for self-employed); if no income, enter "0".

   Monthly amount of other income:    Source:

   Alimony, child support, or separate maintenance income needs to be listed only if you wish such income to be            considered in evaluating this application.

Joint Applicant's References

 * Do you have a checking account?  Yes   No

 * Do you have a savings account?  Yes   No

 * Name of nearest relative / friend not living with you:   Phone#: ()

 * Address:

 * City: ,   * State:    * Zip:

Joint Applicant's Debts and Obligations

                                                             Yes      No               Total monthly payment

 * Rent/mortgage (including tax & ins.)                        

  Credit Union/bank loan                                             

  Visa/MasterCard                                                      

  Department store                                                      

  Travel/oil company                                                    

  Other                                                                        

  Will you be trading in a vehicle?                     

  If Yes,   Loan balance:  Payment amount:

  Have you obtained credit under any other name (s)?    Yes    No

  If so, list name (s) under which credit has been received other than listed above.

  By signing below or submitting this application by e-mail/Internet, you authorize us to gather any information we deem necessary and appropriate, and obtain credit and employment history. Additional information may be needed to process this application. All information provided on this application is true and current. Sierra Hart may provide information to other creditors about our credit experience with you.

 __________________________________                                     _____________________________                              Primary Applicant's Signature                                                             Joint Applicant's Signature                                                  (Signatures not required if returned by e-mail or through the Internet)

  Special Instructions: