Secure Finance Application

Model of Interest

Personal Information

First Name*

Middle Name*

Last Name*

Cell Phone*

Home Phone

Email Address*

Date of Birth*

Social Security Number*

Driver's License State*

Driver's License Number*

Driver's License Expiration Date*

Address Information

Residential Status*

Street Address*

Zip Code*

Years at Current Address*

Monthly Rent or Mortgage Payment*

If you've lived at your current address for less than two years, please provide your previous address information.

Previous Address

Years at Previous Address

Employment Information

Employer*

Employer Phone*

Occupation*

Employer Address*

Employer Country (If not USA)

Gross Monthly Income (Before Taxes)*

Years Employed (Years,Months)*

Additional Income Amount

Additional Income Source

If you've been employed at your current position for less than two years, please provide your previous employer information.

Previous Employer

Previous Occupation

Previous Employer Phone

Previous Employer Address

Reference Information

Relative Name*

Relative Address*

Relative Phone Number*

Relative Relation*

Reference Name*

Reference Address*

Reference Phone Number*

Reference Relation*

Credit Information

Cash Down Payment

If there is a trade do you still owe on it or is there a lien we should be aware of?*

Yes

If Yes, Please Explain:

Have You Ever Obtained Credit Under a Different Name?*

Yes

If Yes, What Name?

Is there anything else we should know regarding this application for credit?

By entering your name below, you represent, acknowledge and agree that: (1) you are submitting this Application for the purpose of applying for a loan and all information furnished in this Application is true, complete, and correct; (2) you are providing “written instructions” to us under the Fair Credit Reporting Act authorizing us to (a) request consumer reports from consumer-reporting agencies and information from credit references and other sources disclosed by you and (b) use such information to update, review, renew, extend, or collect the credit we approve; (3) married applicants may apply for an individual loan; and (4) any loan you receive from us will be used only for personal, family or household purposes. You have the right to request that we inform you of the name and address of each consumer-reporting agency from which we obtain a consumer report on you in connection with this Application. You further acknowledge and agree that typing your name below constitutes your signature and authorizes the processing of your Application.

Signature*

Signature Date*

Add Joint Applicant?

Relationship to Applicant*

First Name*

Middle Name*

Last Name*

Cell Phone*

Email Address*

Birth Date*

Social Security Number*

Driver's License Number*

Driver's License State*

Driver's License Expiration Date*

Address Information

Residential Status*

Street Address*

Zip Code*

Years at Current Address*

Employment Information

Employer*

Employer Phone*

Occupation*

Employer Address*

Time Employed*

Gross Monthly Income (Before Taxes)*

Additional Monthly Income

Is there anything else we should know regarding this application for credit?

Signature*

Date*

Subscribe to Newsletter

Other Income Source

Captcha is required.

By pressing SUBMIT, you agree that DX1, LLC and Fremont Motorsports may call/text you at the number provided, for either informational or marketing purposes, using an automatic telephone dialing system or pre-recorded/artificial voices. Msg/data rates may apply. You don’t need to consent as a condition of any purchase & you may revoke your consent at any time. You also agree to our Privacy Statement & Terms of Use.