5 MINUTE APPROVAL

All fields must be complete filled out

for approvals

APPROVAL INFORMATION FIRST,MIDDLE AND LAST NAME

STREET ADDRESS, CITY, STATE AND ZIP

DOB:

DRIVERS LICENSE NUMBER AND STATE IT WAS ISSUED:

S S N:

DO YOU HAVE A CHECKING'S OR SAVINGS, THAT HAS BEEN OPEN 30 DAYS OR MORE?

RESIDENCE INFO PRIMARY TELEPHONE:

RESIDENCE STATUS

EXACT MOVE IN DATE

LANDLORD NAME AND TELEPHONE NUMBER

RENT AMOUNT

EMPLOYMENT INFO EMPLOYER NAME, ADDRESS, CITY, STATE AND ZIP

SUPERVISOR OR MANAGER NAME AND PHONE NUMBER

OCCUPATION

EXACT HIRE DATE(MUST BE 30 DAYS OR MORE)WILL VERIFY

EXACT MONTHLY INCOME GROSS AMOUNT(BEFORE TAX AND DEDUCTIONS)

NET AMOUNT(TAKE HOME)

AMOUNT OF DOWN PAYMENT:

REQUESTED VEHICLE TYPE:SUV,CAR,ETC

HOW SOON DO YOU NEED OR WANT THIS VEHICLE

COMMENTS

BY CHECKING THE "I AGREE" BOX YOU AGREE TO ALLOW NEXUS MIDLAND TO INPUT YOUR PERSONAL INFORMATION INTO A LENDING DATABASE ,"FOR VEHICLE PRE-APPROVAL PURPOSES ONLY." THE INFORMATION PROVIDED IS TO BE USED SOLELY FOR THE APPROVAL OF A VEHICLE AND YOUR PERSONAL INFORMATION WILL NOT BE SOLD, TRADED OR MISS-HANDLED BY ANY STAFF MEMBER OF THIS COMPANY.

I AGREE

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