Highlands Financial's Credit Application

7340 E. Caley Avenue, Suite 215W, Centennial, CO 80111 | P: (303) 471-8325 | F: (303) 471-8496

Credit Application
- Single
- Joint
Name*
First * Middle Initial Last *
Date of Birth*
MM
DD
YYYY
Social Security Number*
US Citizen?
Current Address*
Street Address
City*
City
State*
State
Zip Code*
ZIP Code
Length of Residence- years/months*
Own / Rent / Other
Monthly Payment
Landlord / Mortgage Company
Previous Address
If less than two years at current residence

Street Address
City

City
State

State
Zip Code

ZIP Code
Length of Residence at Previous Address
Home Phone With Area Code*
Cell Phone
Email Address
Business / Employer*
Occupation*
Business Phone*
Length of Employment- years/months*
Gross Monthly Income*
Additional Income
Source of Additional Income
Previous Business / Employer
If less than two years at present employment
Previous Occupation
Length of Previous Employment- years/months
Co-Applicant Information
Co-Applicant's relationship to Applicant*
Other*
Name*
First Middle Last
Date of Birth*
MM
DD
YYYY
Social Security Number*
US Citizen?
Current Address
<em>Same as Applicant's</em>

Street Address
City

City
State

State
Zip

ZIP Code
Length of Residence- years/months*
Own / Rent / Other
Monthly Payment
Landlord / Mortgage Company
Previous Address
If less than two years at current residence

Street Address
City

City
State

State
Zip Code

ZIP Code
Length of Residence at Previous Address
Home Phone With Area Code*
Cell Phone
Email Address
Business / Employer*
Occupation*
Business Phone*
Length of Employment- years/months*
Gross Monthly Income*
Additional Income
Source of Additional Income
Previous Business / Employer
If less than two years at present employment
Previous Occupation
Length of Previous Employment- years/months
Dealer and Collateral Information
Dealer Name
Dealer's Phone
Dealer's Fax
Submitted By
New / Used
Year
Make
Model
Purchase Price
Down Payment
Trade-In
Payoff Balance on Trade
Sales Tax
Title and Registration Fees
Other Fees
Loan Amount
Additional Comments
Terms and Conditions
Loan Application Terms*
- I/We certify that the information stated above is true and correct and authorize Highlands Financial and or its affiliates to make credit inquiries, share and disclose the necessary information for the purpose of fulfilling this loan request.
Applicant's Name*
First Last
Co-Applicant's Name
First Last
Today's Date*
Date Format: MM slash DD slash YYYY

Credit Application

Co-Applicant Information

Dealer and Collateral Information

Terms and Conditions