Save yourself time and money by prequalifying for a loan! We offer the convenience of competitive financing through Credit Union Direct Lending.

Complete this form and let us help you obtain the lowest interest rate you qualify for so you will be able to concentrate on what type of car best fits your needs when you visit us.

Through our network of 15 lenders and over 140 credit unions we can help you no matter what your credit history in the past may be. Of course we respect customers who wish to obtain their own financing.

Car of interest: (stock number or make, model, year, and color)
Loan requested: $  Down payment:




email address:
Birthdate: / /
Social Security No.:
Mother's maiden name:
Driver's license: State:
Marital status: Married Unmarried Separated
Spouse SSN:
Current address:
City: State: Zip:
Monthly rent/mortgage payment: $
How long: years and months; Phone:
Previous address:
(up to 5 years)

City: State: Zip:
How long: years and months
Income: (per month, gross)
Current employer:
How long: years and months; Phone:
Previous employment:
(up to 5 years)
How long: years and months; Phone:
Spouse Income: (per month, gross)

I certify that the above representations, which are made for the purpose of securing credit, are correct.
I authorize Jeff Holman Auto Center and/or its associates and affiliates to obtain consumer credit reports on me, to gather employment history as necessary and appropriate, and to share the informattion provided in this form with any affilated financial institutions for the purpose of obtaining the requested loan.

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