Secure Lease Application

APPLICANT

First Name:  MI:  Last Name: 

Date of Birth:  Social Security Number: 

Driver's License Number:  Driver's License State: 

Current Address

Address: 

City:  State:  Zip Code: 

Home Phone: 

Length of time at this address:   years  months

Current Employer

Name:  Phone: 

Address: 

City:  State:  Zip Code: 

Length of time at this employer:   years  months

Income

Applicant's gross monthly income from employment: $

Alimony, child support, or seperate maintenance: $

Amount of other monthly income and source(s): $

Total Monthly Income: $

Enter Your Credit Score (if known): 

CO-APPLICANT

Is there a co-applicant?  Yes  No

Asset and Debt Information

Landlord or Mortgage Holder: Payment/Rent: 

Have you ever had any property repossessed?  Yes  No

Do you have any lawsuits pending against you?  Yes  No

Have you ever filed bankruptcy or is a bankruptcy in progress or expected?  Yes  No

Are you in the military reserve?  Yes  No

SUBMISSION

I hereby acknowledge any statements made by me in reference to my credit is true, correct, and complete.  Yes  No

Before submitting your credit application, please review for accuracy.

Application or approval for credit is not a guarantee of availability of a particular vehicle. Contact Payless Auto Leasing for exact inventory.

Important Notice: This On-line Credit Application is for U.S. residents only (applying as individuals, not as a business). This is an official Credit Application and, as such, a credit bureau inquiry under your name will be processed each time you submit an application. Any Credit approval is valid at Payless Auto Leasing only and is subject to finalization of vehicle selection and leasing structure.


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