Bettis Autoland Credit Application
Please fill out all the fields below, unless they are not applicable, read the privacy policy, check the "I Agree" box, and submit this application to be evaluated.
Last Name:
First Name:
Middle Initial:
Social Security# - -
Date of Birth: (mm/dd/yyyy)
Street Number:
Street Name:
Street Type: (Rd., Lane, etc)
Apt. Number:
City:
State:
Zip Code:
Primary Phone: ( ) - ext.
Primary Phone Type:
Additional Phone: ( ) - ext.
Additional Phone Type:
Alternate Phone: ( ) - ext.
Alternate Phone Relation:
   
Email Address:
Please choose vehicle you are inquiring about: Stock#
   
Bank Name:
Checking Acct#:
Savings Acct#:
Direct Deposit:
   
Employer:
Occupation:
Length of Employment:
Hire Date:
Employer Phone: ( ) - ext.
Military Rank:
   
Income:
Frequency:
Type:
Pay Structure:
Other Verifiable Income (monthly):
Other Income Source:
Is there a Co-Maker:
   
Own/Rent:
Monthly Payment:
Landlord Name:
Landlord Address:
Landlord Phone number: ( ) -
How long at residence:
   
   
PRIVACY POLICY
I acknowledge that pursuant to the Fair Credit Reportin Act, my application will be submitted to Credit Acceptance Corporation, a Michigan corporation, and/or any of its affiliates or subsidiaries or divisions ("Credit Acceptance") for review in connection with the assignment of a sales finance contract written, or to be written, in connection with my purchase.

I certify that the above information is complete and accurate. In connections with this application, I authorize and give Seller and Credit Acceptance my consent to obtain my credit report from any Credit Reporting Agency and complete an investigation of my credit and employment history and release information about my credit experience with Seller and/or Credit Acceptance. If and after my contract is assigned to Credit Acceptance, I also authorize and give consent to Credit Acceptance to obtain my credit report from any Credit Reporting Agency at any time during the term of my contract for any purpose whatsoever, including but not limited to for prescreening, as defined and permitted from time to time by the federal Trade Commission; for reviewing my contract; to defer or extend my payments or due date under my contract; to take collection action on my contract; or for other legitimate purposes associated with my contract. I understand and acknowledge that Credit Acceptance will retain this application whether or not it is approved. I also understand and acknowledge that if I ask, I will be informed if a credit report has been requested in connection with this application for credit, and the name and address of the Credit Reporting Agency that furnished the report.

Email Communication: By checking below, I authorize and give consent to Credit Acceptance to use the email address I have provided on this application to communicate with me for any purpose whatsoever, including but not limited to communications regarding my account activity, status and collections.

Spousal Consent: By signing below I authorize and give consent to Credit Acceptance to discuss my account with my spouse, if applicable, including discussing my account activity, status and payment arrangements.

I Agree (REQUIRED!)
 
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