Murrys Nissan

Finance

Fill out the form below to apply for financing. We will contact you with the results of this application based on the method you choose below. If you have any questions or problems, feel free to call us at: (918) 683-6605 and we can take your application over the phone.

How do you prefer to be contacted with the results of this application?

Your Phone # or E-mail Address:

APPLICANT INFORMATION (MARRIED MAY APPLY AS AN INDIVIDUAL)
APPLICANT (principal driver of vehicle)
Full Name:
Street Address:
City, State & Zip:
How long at this address?	Years: Months:
Home Phone:
Date of Birth:	Month: Day: Year:
Social Security #:
Own Home	Live with relative
Rent/Lease	Other
Monthly Payment:
JOINT APPLICANT (this section is optional)
Relationship:
Full Name:
Street Address:
City, State & Zip:
How long at this address?	Years: Months:
Home Phone:
Date of Birth:	Month: Day: Year:
Social Security #:
Own Home	Live with relative
Rent/Lease	Other
Monthly Payment:
EMPLOYMENT
APPLICANT (principal driver of vehicle)
Employer Name:
Employer Address:
City, State & Zip:
Length of Employment	Years: Months:
Work Phone:
Position/Title:
Gross Annual Salary:	$
**Other Income Source:	$
Previous Employer:
Length of Employment	Years: Months:
JOINT APPLICANT (this section is optional)
Employer Name:
Employer Address:
City, State & Zip:
Length of Employment	Years: Months:
Work Phone:
Position/Title:
Gross Annual Salary:	$
**Other Income Source:	$
Previous Employer:
Length of Employment	Years: Months:
**Alimony, Child Support or Separate Maintenance Income need not be revealed if you do not wish to have it considered as a basis for repaying this debt.

NOTICE: I, the undersigned, hereby authorize the dealer, Nissan Motor Acceptance Corporation, Nissan-Infiniti LT (collectively "Prospective Creditors") to verify credit and employment history as stated above and to answer questions about credit experience wit me. If this application is made pursuant to any credit program for attendees and/or graduates of schools or educational institutions, then prospective creditors may verify my eligibility for such program, including by inquiry to my school(s) or educational institution(s). Insurance related to the credit for which I am applying may be purchased from an insurer or agent of my choice who meets prospective creditor standards. In connection with this application for credit, prospective creditors may request a consumer (credit) report. On my request, prospective creditors will advise me if the report was actually ordered and if so, the name and address of the agency that furnished the report. Prospective creditors may order subsequent consumer (credit) reports.

I authorize prospective creditors to ask my past and current creditors ("Credit References"), including creditors listed above or on my consumer (credit) report, about my credit performance with them. Provision by prospective creditors of a copy of this authorization shall serve as my direction that my credit references provide my credit performance information.

Everything that I have stated in this application is correct to the best of my knowledge. I understand that prospective creditors will retain this application whether or not it is approved. I will notify prospective creditors, if applicable, within a reasonable time of any change in my name, address or employment.

Signature of Applicant:
Date:
Signature of Joint Applicant:
Date: