Hey it's Adrienne! I work closely with the team at My Credit Counsel, the industry experts in obtaining auto financing during or after a bankruptcy. Their process is fast, and confidential. Thank you for trusting me and my partners with helping you on this journey!

Credit Application Form

Full Name

Title (Mr, Mrs, Ms) *

First Name *

Last Name *

Email *

[email protected]

Current Address

Address *

Street Address

Country

Country

State

City

Postal code

Years at current address *

Have you lived at the above address for more than 2 years? *

Yes

No

Previous Street Address

Previous City

Previous State/Province

Previous Country

Previous Postal Code

Years at previous address

Personal Information

Phone *

Please enter a valid phone number

Date of birth *

Driver's License *

Social Security Number (no dashes) *

Employment Information

Are you currently working? *

Name of Employer

Start Date at this employer

Position Title

ex. Manager, Clerk, Driver

Employer Phone Number

Please enter a valid phone number

Have you worked at the above employer for more than 2 years?

Yes

No

Previous Employer (if less than 2 years at current employer)

Previous Employer Phone Number

Please enter a valid phone number

Years at Previous Employer

Months at Previous Employer

Financial Details

Current Bank Name *

Account Type *

Checking

Savings

Other

Do you own or rent your home? *

Own

Rent

How much is your monthly Rent or Mortgage payment? *

Monthly Gross Income (before taxes are deducted) *

Have you previously filed a Bankruptcy? *

If you answered Yes above, is it open or discharged?

Car Loan Information

Do you have any current car loans? *

Yes

No

How many car loans do you have a balance on?

Loan #1

Bank Name
Payoff Amount
Monthly Payment Amount
Is this a trade-in? (Yes/No)

Loan #2

Bank Name
Payoff Amount
Monthly Payment Amount
Is this a trade-in? (Yes/No)

Loan #3

Bank Name
Payoff Amount
Monthly Payment Amount
Is this a trade-in? (Yes/No)

Trade-In Vehicle Information

Are you trading in a vehicle? *

Yes

No

Make and Model

Year

VIN #

Recorded Mileage

Requested Loan Details

Loan Type *

Used Car

New Car

Down Payment Amount for New Vehicle *

<1000

1000-2000

2000-3000

3000-4000

More than 5000

Co-Signer Information

Please have co-signer complete below if applicable

Do You Have A Co-Signer? *

Yes

No

Co-Signer First Name

Co-Signer Last Name

Co-Signer Street Address

Co-Signer City

Co-Signer State/Province

Co-Signer Country

Co-Signer Postal Code

Co-Signer Phone Number

Co-Signer Social Security Number

Co-Signer Date of Birth

Co-Signer Employer

Co-Signer Start Date of Employment

Co-Signer Position with Employer

Co-Signer Employer Phone Number

Co-Signer Previous Employer (If Current Employer is Less Than 2 Years)

Co-Signer Previous Employer Phone Number

Co-Signer Years at Previous Employer

Co-Signer Months at Previous Employer

Upload Documents

Upload a copy of the front of your Driver's License *

Latest Paycheck #1 *

Latest Paycheck #2 *

Signatures

Your Signature *

Clear

Co-Signer's Signature

Clear