Bob Crock
Internet Sales Manager
3101 7th Street
Parkersburg, WV 26101
Sales/Service/Parts/Body Shop: (304) 424-5122
Internet Sales: (304) 966-2068
[email protected]
Home
Inventory
New Hyundai
Used Inventory
Get A Quote
Finance
Credit Application
Payment Calculator
Privacy Policy
Parts
Order Parts
Parts Specials
Service
Make An Appointment
Service Specials
Maintenance
Dealer Info
Dealership News
About Us
Contact Us
Map and Directions
Careers
OUR STAFF
Specials
Vehicle Specials
Rebates and Incentives
Videos
Meet the Staff
Finance Application
Please read our privacy policy
The form will be submitted using a secure HTTPS form action. All sensitive data is encrypted before transmission and is never sent as clear-text.
FullName
Email
MiddleName
First Name:
*
Middle Initial:
*
Last Name:
*
Who is your salesperson? If none, then enter N.A.
Date of Birth (mm/dd/yyyy):
*
SSN#:
*
Address:
*
City:
*
State:
*
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
ZIP:
*
If less than 2 years, Prevoius Address:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Phone:
*
Email:
Residence:
*
Own home outright
Buying Home
Renting/Leasing
Living with relatives
Monthly Payment:
*
Time at residence:
*
Education Level (if under 27)
4 Year College Grad.
2 Year College Grad.
Some College
Special Training
High School Grad.
Current Employer:
*
Employer's Address:
*
Applicant's Occupation:
*
Time at Current Job:
*
Work Phone:
*
Gross Salary:
*
Other income:
Type of Other Income
Social Security
Disability
Self Employment
Alimony or Palimony
Child Support
Other
Name of Bank:
Type of Account:
Checking and Savings
Checking only
Savings only
No account
Have you ever had a car or other merchandise repossessed?
*
Yes
No
Have you ever filed bankruptcy?
*
Yes
No
Do you have a co-applicant?
*
Yes
No
Co-Applicant First Name:
Co-Applicant Middle Initial
Co-Applicant Last Name:
Co-Applicant Date of Birth: (mm/dd/yyyy)
Co-Applicant SSN#
Co-Applicant Address:
Co-Applicant City:
Co-Applicant State:
Co-Applicant Zip:
If less than 2 years, Previous Address:
Co-Applicant Previous City:
Co-Applicant Previous State:
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Co-Applicant Phone:
Co-Applicant Email:
Co-Applicant Residence
Own home outright
Buying Home
Renting/Leasing
Living with relatives
Co-Applicant Montly Payment:
Co-Applicant Time at residence:
Co-Applicant Current Employer:
Co-Applicant Occupation:
Co-Applicant Employer Address:
Co-Applicant Time at Current Job:
Co-Applicant Work Phone:
Co-Applicant Gross Salary:
I (and Co-Applicant) have read the Privacy Statement and fully understand its terms.
*
Yes
No
BY SUBMITTING THIS CREDIT APPLICATION I (AND CO-APPLICANT) AUTHORIZE A CREDIT CHECK WHICH INCLUDES PULLING STATEMENTS FROM THE CREDIT BUREAU AND OTHER CREDIT REPORTING AGENCIES
*
Yes
No
Responsive Dealer Website provided by
Dominion Dealer Solutions
