Leeson's Online Credit Application
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Fill out, print then fax to: 1-304-842-5848

APPLICATION FOR DEALER ARRANGED LOAN

INDIVIDUAL   JOINT   BUSINESS

Please fill out the form as completely as possible..

Full Name of Primary Applicant
Driver's License No
Date of Birth
Social Security No.
No. of Dependents
Present Street address
Address (cont.)
City
State
Zip code
County
How Long? Years Months
   
Previous Street address
Address (cont.)
City
State
Zip code
County
How Long? Years Months
   
Home Phone
Rent or Mortgage Payment
Landlord/Mortgage Holder
Own Home? Yes No
Purchase Price
Mortgage Balance
Approx Value of Home
   
Name Of Relative Not Living With You At This Address
Street address
Address (cont.)
Phone
Relationship
     
Occupation
Phone
Employer
Address
How Long? Years Months
     
Previous Occupation
Previous Employer
Address
How Long? Years Months
Gross Wage or Salary Weekly Monthly Yearly
Name of Bank  
Branch  
  Checking Savings  
Other Income Weekly Monthly Yearly  
Source  
NOTE: 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 obligation.
     
COMPLETE THIS SECTION ONLY IF APPLICATION IS FOR JOINT CREDIT WITH ANOTHER PERSON
Print Full Name of Joint Applicant  
Driver's License Number  
Date of Birth  
Social Security Number  
Number of Dependents  
Present Address  
City  
State  
Zip  
County  
How Long? Years Months  
Home Phone  
Business Phone  
Own Home?  
Rent or Mortgage Payment  
Landlord or Mtg Holder  
Occupation  
Phone  
Employer  
Address  
How Long?  
Gross Wage or Salary Per Week Per Month Per Year  
Name of Bank  
Branch  
  Checking Savings  
Other Income Per Week Per Month Per Year  
Source  
NOTE: 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 obligation.
     
Auto: Make and Year  
Financed With  
Title in Name of:  
Monthly Payments Amount Owed:  
  Keeping Trading Selling  
Name and Address of Past and Present Creditors - 1
Name  
Address  
Acct in name of:  
Type of Loan  
Account Number  
Monthly Payment  
Balance Owed  
Name and Address of Past and Present Creditors - 2
Name  
Address  
Acct in name of:  
Type of Loan  
Account Number  
Monthly Payment  
Balance Owed  
Name and Address of Past and Present Creditors - 3
Name  
Address  
Acct in name of:  
Type of Loan  
Account Number  
Monthly Payment  
Balance Owed  
Name and Address of Past and Present Creditors - 4
Name  
Address  
Acct in name of:  
Type of Loan  
Account Number  
Monthly Payment  
Balance Owed  
     
Collision and Comprehensive Insurance is Required. The Huntington National Bank Must be Listed as Loss Payee
Agent's Name  
Agent's Address  
New Used
Demo
Term  
Year No Cyl
Make Model
Air Cond Sun Roof Cruise Pwr Window
Stereo/Tape Leather Int Auto Trans Tilt
M.S.R.P. Mileage  
VIN (Full)  
Trade In Year Make Model
Where Financed  
CASH PRICE (Includes Tax, Title, Fees)
Cash Down Payment
Gross Trade-In
Payoff
Net Trade-In
Rebate
Total Down Payment
Unpaid Balance
Extended Service Warranty
Credit Life, A&H
Amount Financed (TOTAL)
I/we understand that the above named Dealer will request Huntington National Bank West Virginia to finance the purchases requested in this application, and I/we authorize Huntington National Bank West Virginia to disburse the proceeds of this loan to that dealer.

I/we certify that each of the statements made and answers given in this credit application is true and correct and is made for the purpose of inducing the financing of the purchase of the motor vehicle described in this application.

I/we authorize the obtaining of a consumer report to be used in evaluating this application and the obtaining and exchanging of credit information from and with other creditors and consumer reporting agencies.

THE WEST VIRGINIA LAWS AGAINST DISCRIMINATION REQUIRE THAT ALL CREDITORS MAKE CREDIT EQUALLY AVAILABLE TO ALL CREDITWORTHY CUSTOMERS AND THAT CREDIT REPORTING AGENCIES MAINTAIN SEPARATE CREDIT HISTORIES ON EACH INDIVIDUAL UPON REQUEST. THE WEST VIRGINIA CIVIL RIGHTS COMMISSION ADMINISTERS COMPLIANCE WITH THIS LAW.

Applicant's Name Date
Joint Applicant's Name Date