Get Approved

*** IMPORTANT: Before you fill out this form make sure you meet our following conditions:
- Have a phone in your name
- Have a utility bill in your name (cable bill accepted)
- Have been employed for a year (maximum of 2 jobs)
- Live at your current residence for at least 1 year
- If self employed you must have last years 10-99 tax return
- If you have declared bankruptcy it must be discharged
- Live within 100 miles from Wichita and in Kansas
(Note: payments will be affected by down payment)

Vehicle Information
Year
Make
Model
Trim Level (if applicable)
Stock Number (if available)
Contact Information
First Name *
Last Name *
Middle Initial
Date of Birth *
Age
Social Security Number *
Address *
City *
State *
Zip *
How long have you lived there? *
Do You: *	Own Rent / Lease Live with relative Other
Home Phone Number *
Work Phone Number *
Email Address *
Best time to contact
Have you Lived in your current address for less than two years? If yes, then please provide your previous address:
Previous Address
Previous City
Previous State
Previous Zip
Employment / Income / Assets Information (Current)
Education *	College Grad Some College Special Training Highschool
Income from alimony, child support, or sep maintenance need not be revealed if you do not wish to have it considered for basis of repaying the obligation.
Employer Name *
Years *
Months *
Position or Title *
Employer Address
Gross Annual Income *
Income *
Other Income Source
Have you worked at your current job for less than two years? If yes, then please provide your previous employer:
Previous Employer Name
Years
Months
Mortgage Company or Landlord *
Monthly Obligation *
Life Insurance Company
Amount $
Disability: % of income
Banking (Checking/Savings)
Average Daily Balance
Vehicle trade in information
Lien With
Trading
Loan Balance
Cash Down
Protection Cancellations?
Who Performs your Routine Maintenance?
Estimated Annual Miles?
Are You Currently Working With A Sales Rep? If So, Who?
Date
E-Signature *