Pocono Auto Mart : Your Key to the Pocono's finest re-conditioned pre-owned vehicles.

The Pocono Lending Source will help you get that car you've always wanted!
ALL INFORMATION PROVIDED WILL BE KEPT CONFIDENTIAL

First Name:

Middle Initial:

Last Name:

Address:

City:

Phone #:
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County:

State:

Zip:

Years there:

Previous Address:

Years there:

Cell Phone #:
()

Date of Birth:

Social Security Number:

Email:

Employer Information

Employer:

Work Phone #:
()

Employer Address:

City:

State:

Zip:

Position:

Salary:

Years there:

Financial Statement

Bank Name:

Accounts Open:
Checking Savings

Type of Obligation	Name of Creditor	Monthly Payment
Mortgage
Auto Loan
Credit Card

By submitting this application you authorize the Pocono Automart Inc. (the dealer) to share your nonpublic personal information with affiliated third parties (e.g. a bank). The dealer will not disclose, nor reserve the right to disclose any nonpublic personal information to third parties without your permission. The dealer's security practices include limiting access to your information to only employees with appropriate authority and for intended credit business purposes only.

Every statement I/we have made in this application is true and correct and has been made by me with the understanding that you will rely on it. I agree that if anything arises which changes any of the statements I have made, I will promptly tell you. You may request a credit report on me and if I ask, you will tell me the name and address of the consumer reporting agency who furnished it. If you update, renew or extend my loan, you may request a new credit report without telling me. NOTE: By submitting this application. you will authorize above dealer: Pocono Auto Mart, to check your credit.