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TOLL FREE 888-259-3009
In Cassville 417-847-2151
APPLY ON-LINE!
Now that you can apply online, you can be driving the New or Pre-Owned Ford or Mercury of your choice in no time. COMPLETE THE FORM ONLINE...THEN PRINT FORM & FAX TO 417-847-3855.
YOU'LL GET A CALL
Once you fill out and submit the credit request form, you can expect us to give you a call as soon as we have processed your information. Please fill in every question of the form so we can get you in the vehicle you want as soon as possible. You may telephone us if you have any questions. 
CHECK ONE APPLICABLE BOX (PRIMARY APPLICANT AND JOINT APPLICANTS MUST COMPLETE SEPERATE FORMS:
 Primary Applicant
 Applicantion is for joint credit with primary applicant or as a guarantor.
 Primary applicant is relying on you for income for alimony, chilc support, or seperate maintenance or on your income or assets as the basis for
  repayment of the credit requested.
If Joint Applicant, Relationship to Applicant
S - Married O - Other P - Parent
Last Name First Name
Middle Name Date of Birth
Social Security Number
Driver's License No. and State
Present Address (Number and Street, City, State, Zip Code)
Mailing Address (If different)
County
Pnone in Applicant's Home? Yes No Phone Number & Area Code
PleaseSelectOne: Lived There Months
Name and Address of Landlord or Mortgage Holder
Rent or Morg. Pmt. $
Previous Address (Street, City, State and Zip Code) Lived There Yrs.
Level of Education (Age Under 27 Only) Current Employer Name
Applicant's Occupation (If Military, State Rank)
WorkPhone Number with Area Code Gross Monthly Salary $ Time on Job Yrs. Mos.

* Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repayint this obligation.

•Source of Other Income Other Income $
Previous Employers Name (If less than 5 years at current employer)
City/State
Name of Bank Checking & Savings Checking Only Savings Only No Account

Creditor's name and City/ State
Date Opened

Monthly Payment

Unpaid Balance
     
     

Name, Address & Phone Number of Applicant's Nearest Relatives/Friends Not in Household

For the purpose of securing credit from you, I certify that the above information is true and complete to the best of my knowledge.
Applicant further certifies that I have attained the age of majority. Applicant authorizes you, to check my credit and employment
history and to provide and/or obtain information about credit experience with me.

FOR USE

SELLERS ONLY		 New
Used 		Vehicle ID Number
Year
Model
Make
Body Style (If Used Vehicle)

Optional Equipment (If used vehicle)

Air

P/S

 P/B Auto Tr. Other
Trade
Make
Model
 Body Style
Dealer Name
I acknowledge by signing this document that I have read this form.
The dealer and its assigns may share and use information about you, including information in this application, with entities that are related by common ownership or affiliated by common control. If you do not want this information shared with these entities, please mark the box provided below:
By checking this box, I do not want this information shared (other than information on transactions or experiences with me).
Applicant Signature: _____________________________________ Time: ________ Date: ________
Joint Applicant Signature: _________________________________ Time: ________ Date: ________
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