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Individual Business

1. Vehicle Information

* Vehicle Year

* Vehicle Make

* Vehicle Model

* New or Used New Used

Vehicle Mileage

* Vehicle Body Style

Dealer

* Purchase Price

* Term of Lease in Months

* Down Payment

* Registration State

2. Personal Information

* First Name

Middle Name

* Last Name

* Street Address

* City

* State

* Zip Code

* Phone

* Email

* Confirm Email

* Date of Birth

* Social Security Number

Citizenship

* Own or Rent

Own Rent

* Number of Years

* Mortgage Holder or Landlord

Payment Per Month

Previous Address if less than two years

3. Employment Information

* Employer

* Employer Address

* Employer City

* Employer State

* Employer Zip

* Employer Phone

* Position

* Years Employed

* Verifiable Personal Income

Additional Income

Additional Income Source

Previous Employer if less than two years

* How did you find Premier?

The above information is correct to the best of my knowledge. Premier Financial Services, LLC (PFS) will rely on this application in deciding whether to grant the requested credit and may keep this application on file. I authorize PFS, and its affiliates, to review my credit and employment history, and, if approved, obtain future credit reports as necessary. PFS will safeguard my information and will use it for internal purposes only. I understand that federal law requires financial institutions to obtain, verify, and record identifying information. Indicate that you understand and agree with the above statement by typing your name below:

Checking this box indicates that I understand and agree with the above statement

* Required Fields