Road Runner Auto - Finance Form

2100 16th Avenue SW

Cedar Rapids, Iowa 52404

(319) 265-2100

Hours:

Monday - Friday: 8 AM - 6 PM

Saturday: 9 AM - 3 PM

Road Runner Auto Credit Application

About You

Buyer

Co-Buyer

(Complete a separate application for each buyer.)

For your security, this credit application is offered in a secured environment, protected by 128-bit SSL encryption. Please verify that the URL in the address bar of the browser window begins with HTTPS and/or that the security lock icon is displayed.

Name:

Social Security
Number:

Date of Birth:

Home Phone:

Work Phone:

Cell Phone:

Email:

Best Way to Reach You:

Length at Current Address:

Years

Months

(If less than 2 years, complete Previous Address section.)

Address:

Current Address

City:

State:

Zip:

Own:

Rent:

Family:

Other:

If Other:

Monthly Mortgage / Rent:

Length at Previous Address:

Years

Months

(If less than 2 years at current address,
complete this section.)

Previous Address

Previous
Address:

City:

State:

Zip:

Own:

Rent:

Family:

Other:

If Other:

Previous Monthly Mortgage / Rent:

(If less than 2 years at current employer,

complete this section.)

Your Trade In Vehicle

Current Employment

Previous Employment

Your New Vehicle

Employer Name:

Job Title:

Employer Phone:

Annual
Gross Salary:

Or
Hourly Rate:

Full Time:

Part Time:

Hours
per Week:

Length of
Employment:

Years

Months

(If less than 2 years, complete Previous Employer section.)

Other Income:

(Rental Property, Child Support, 2nd Job, etc)

Gross Monthly Amount

Employer Name:

Job Title:

Employer Phone:

Annual
Gross Salary:

Or
Hourly Rate:

Full Time:

Part Time:

Hours
per Week:

Length of
Employment:

Years

Months

Year:

Make:

Model:

Price Range:

Cash
Downpayment Amount:

Or Other Vehicle:

Or Monthly Payment Range:

Year:

Make:

Model:

Trim:

Mileage:

Amount Owed:

Lien Holder:

I hereby grant permission to you to obtain any information you deem necessary to process my loan application. This information includes, but is not limited to, my past and present employment status, my deposit accounts, my past and present consumer credit record and my mortgage and rental payment record.

I also grant permission to use my electronic signature in order to obtain any information regarding the items mentioned above.

Your Electronic Signature: