Credit Application (English)

Location

Moody Sales Reps

Salomon Correa
Marie Fogo
James Giles
Eric Velez Ruiz

Personal Information

First Name

Last Name

Date of Birth

City

State

ZIP Code

Time in Birmingham Metro Area

Time at Present Address

Home Phone No.

Mobile Phone No.

Social Security No.

Driver's License No.

Driver's License Expiration Date

How many residence changes in last 2 years?

Have you declared bankruptcy in the last three years?
Yes No

Have you consulted with an attorney in the last 3 months about filing bankruptcy?
Yes No

Do you or a family member have a current account with LR Auto Sales?
Yes No

If yes, what is the name of the family member who has an account?

Have you had a car repossessed or voluntarily turned in in the last 3 years?
Yes No

If yes, how many times have you had a car repossessed or turned in in the last 3 years?

How many miles would you estimate you drive each day?

I authorize LR Auto Sales/Trinity Financial/Top Gear Services to contact me via email, text or Facebook.
Yes No

How often do you drive for Uber/Lyft/DoorDash, etc?

Do you own another vehicle?
Yes No

Work Information

Employer Name

Employer Phone No.

City

State

ZIP Code

Job Position

Take Home Income/Month/Week/Bi-Weekly

Time Employed

Supervisor Name

Number of job changes in the last two years?

You may complete the boxes below if you have another job or other income to report.

Employer Name

Employer Phone No.

City

State

ZIP Code

Job Position

Take Home Income/Month/Week/Bi-Weekly

Time Employed

How do you get paid?
Weekly Bi-Weekly Monthly Semi-Monthly

Alimony, child support or other separate income need not be revealed if you do not wish to have this income considered as a basis for repaying this loan obligation.

Home/Apartment

Car Payment

Phone

Food

Power & Gas

Vehicle Insurance

Credit Card

Water

Cable

Entertainment

Other

Total

All 8 references MUST be completed to finalize application

References - 4 Relatives

Name

Relation

Phone No.

Time in Birmingham Metro Area

Name

Relation

Phone No.

Time in Birmingham Metro Area

Name

Relation

Phone No.

Time in Birmingham Metro Area

Name

Relation

Phone No.

Time in Birmingham Metro Area

References - 4 Friends

Name

Relation

Phone No.

Time in Birmingham Metro Area

Name

Relation

Phone No.

Time in Birmingham Metro Area

Name

Relation

Phone No.

Time in Birmingham Metro Area

Name

Relation

Phone No.

Time in Birmingham Metro Area

Name of Person who Referred You

I understand that by signing this Loan Application I hereby permit LR Auto Sales, Inc. to access my EquiFax Credit Report. I understand the purpose is to verify my identity and the ultimate decision of the finance company is subject to a number of factors.
LR Auto Sales, Inc. does not discriminate on the basis of age, gender, race, religious affiliation, mental or physical ability, veteran status, military obligation(s), or national origin.

We Make It Happen

Credit Application (English)

Apply Online

Personal Information

Work Information

All 8 references MUST be completed to finalize application

References - 4 Relatives

References - 4 Friends

By submitting your information, you are authorizing LR Auto Sales to contact you via text, email, and phone as it relates to your submission. You can unsubscribe at any time. Message and data rates may apply. Message frequency varies.