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Americhoice Agency, Inc.  

Auto Finance Qualification/Request Form  

First name
Last name
Home phone
How long at this address? years (Note: most lenders/dealers require 1 year minimum)
Rent or own? Rent Own
Monthly payment
Date of birth (Note: must be 18 or older)
Social Security # (Note: enter it with dashes - e.g. 123-45-6789)
Employer name
Your job title
How long with this employer years (Note: most lenders/dealers require 1 year minimum)
Monthly income (Note: usual minimum is $1,500)
Work phone
Declared bankruptcy in the last 7 years? No Yes
Cosigner available (if needed)? Yes No

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