1 2 3 Co-Buyer Credit ApplicationHelp us help you by completing application truthfully. All information provided on credit application will be verified and providing false information on the credit application will automatically disqualify you for approval.How did you hear about us?*First*Middle*Last*Address* Street Address or P.O. Box City State / Province / Region ZIP / Postal Code Cell Phone*Home Phone*Work PhoneEmail Address* SSN#*Date of Birth*Driver's License #*Residence (check one)* Live with others Live with parents Rent - no contract Lease - with contract Own/BuyingResidence (check one)* 0-6 Months 7-12 Months 13-35 Months 3-5 Yes Over 5 YearsPrevious Address Street Address City State / Province / Region ZIP / Postal Code Start Date at Address End Date at Address Number of years lived within 50 miles of Mesa since age 18?Employment History & IncomeCompany Name of Current Employer*Job Status*Full-TimePart-TimeTemporaryPhone #*Address Street Address City State / Province / Region ZIP / Postal Code PositionSupervisor NameMonthly Gross Income*Length of Employment*1 Year or Less1 to 2 Years2 to 3 Years3 to 4 Years5 + YearsName of Previous EmployerPhone #PositionLength of EmploymentMonthly Gross IncomeWhat is the other source of income?Amount per monthTotal Monthly Household Gross/Net Income, including spouseCurrent Vehicle OwnedYearMakeModelDate Purchased Dealer/Seller's Name of Current VehiclePrevious automobile finance companyHave you ever had a vehicle repossessed?NoYesSelect which one below applies3 in the last 3 years2 in the last 3 years1 in the last 3 years0 in the last 3 yearsHave you ever filed bankruptcy?NoYesDate of bankruptcy Dismissed?NoYesThird ChoiceFamily ReferencesSpouse's NameAddress Street Address City State / Province / Region ZIP / Postal Code Date of Birth Driver's Licencse #SSN #NameAddress Street Address City State / Province / Region ZIP / Postal Code Cell PhoneHome PhoneNameAddress Street Address City State / Province / Region ZIP / Postal Code Cell PhoneHome PhoneNameAddress Street Address City State / Province / Region ZIP / Postal Code Cell PhoneHome PhoneNameAddress Street Address City State / Province / Region ZIP / Postal Code Cell PhoneHome PhoneCo-Workers or Personal ReferencesNameAddress Street Address City State / Province / Region ZIP / Postal Code Cell PhoneHome PhoneNameAddress Street Address City State / Province / Region ZIP / Postal Code Cell PhoneHome PhoneNameAddress Street Address City State / Province / Region ZIP / Postal Code Cell PhoneHome PhoneAuthorizationI authorize RED MOUNTAIN FUNDING INC. to check my credit, my employment history and my references and I have answered all other financial questions true and correct to the best of my knowledge.* I agree I do not agreeDate of Authorization* Today's dateNameThis field is for validation purposes and should be left unchanged.