Hillside Motors Inc. | Hickory, NC

First
Name

Middle

Last
Name

Jr.
Sr.

Date of birth

Social
Security #

Mothers
Maiden Name

Phone in
Applicants Home

Phone in
Applicants Name

Phone #

Your E-mail Address

Drivers License #

State Issued

Name and Address of Landlord or Mortgage Holder

Landlord or Mortgage Holder Phone

If Less than 3 Years at Current Address, Please includes Previous Address History Below

Street Address			Apt, or Lot#
City			State			Zip Code		Time at Address yrs mos

Employed by or Type of business

Position

Address

City

State

Zip

Gross (Pre-tax)
Monthly Income

Supervisor

Time Employed yrs mos

Work Phone

Source Of Other Income (1)

Monthly Amount

Total monthly gross income (this amount is automatically calculated)

If Less than 3 Years at Current Employment, Please includes Previous Employment History Below

Previous Employer

Time Employed yrs mos

Phone

Address

City

State

Zip

Have you ever had a car repossessed?		Date
Have you ever had a Forclosure?		Date
Have Civil Judgements ever been laid against you?		Date
Have you ever filed for Bankruptacy?		Date

Do you have a trade?

Down Payment

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1240 Hwy 70 SE.
Hickory, NC 28602
Phone: 828-327-3713