Customer Service: (928) 377-5364
Business Office: (928) 377-5365

Colorado River Ford Lincoln
3601 Stockton Hill Road
Kingman, AZ 86409

Colorado River Ford Superstore
2585 Highway 95
Bullhead City, AZ 86442

 
 
Loan Application
General information
First Name: *
Last Name: *
Date of birth:
 
E-mail Address: *
Phone Number: *
Fax Number:
SSN:
Next of Kin:
 
Residential Address Information
Street Address:
Unit, Suite or Apt:
City:
State/Province:
Zip/Postal code:
Time at Current Years
Residence: Months
 
Previous Address Information
Street Address:
Unit Suite or Apt:
City:
State/Province:
Zip/Postal code:
Time at Previous Years
Residence: Months
 
Mailing Address
Street Address:
Unit Suite or Apt:
If Different Than Residential Address (optional)
City:
State/Province:
Zip/Postal code:
 
Housing Information
Primary Residence:
Total Years You Have Been a Homeowner:
Estimated Monthly Housing Payments: $
Include all mortgages or rent, property taxes, homeowners fees, and insurance
 
Employment Information
Employment Status:
Description:
Present Employer:
Time Employed: Years Months
Phone: Ext
City:
State/Province:
Zip/Postal code:
Street Address:
Mailstop, Suite or Floor:
Floor:
Gross Monthly Income: $ Monthly
 
Liquid Assets / Income / Expenses
Liquid Assets: $
Total of checking, savings, money market, stocks, bonds, and mutual funds. Please do not include equity in your home, retirement monies, restricted stock or unvested options
Other Monthly Income: $
Source of Other Monthly Income 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 your loan
Expenses & Liabilities: $
Credit Score or Range: $
 
Your Loan
Product Selected:
Type Selected:
Vehicle Motorized Type:
Vehicle Make:
Vehicle Model:
Current monthly payment: $
Loan Amount Requested: $ *
Term in Months: *
Down Payment: $ *
Do you have a vehicle you wish to trade in?   
 
Optional Financing Referral Service
East Tennessee Dodge Chrysler Jeep is committed to helping you finance your vehicle. In the event we are unable to provide you with a vehicle loan, we offer an optional service that could help you obtain financing.
Your financial application data or credit information will not be shared. We will forward only your intended make and model and contact information (name, address, phone number and e-mail address) to institutions who meet the criteria for your financing needs.
   
 
Billing Choice
Please choose Automated Payment Option or Invoicing Payment Option.
days
days
 
Special Instructions
Please note any special time or range of times which you desire us to contact you, if different from above. We can contact you at any time during our regular business hours.
 
Security

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