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Lewis Auto Sales Secure Credit Application
  • Personal Info
    First Name: *
    Middle Name:
    Last Name: *
    Home Phone: *
    Mobile Phone: *    Same as Home

    Entering your phone number here constitutes an inquiry to us and you consent to be contacted by phone, email, or SMS text to discuss your interest in credit, even if you do not click the button to accept our terms and submit or complete this entire application.
    Email: *
  • Identification
    Date of Birth: *
    Social Security/ITIN Number: *



  • Residence

    Present Address

    Street #: *
    Street Name: *
    Apt/Unit:
    Time at this Address: *
      
    Zip: *
     
    City: *
    State: *
    Owned By: *
    Monthly Cost: *




      

     


  • Income
    Employment Status: *
    Monthly Gross Income: *
    Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

    Other Income

    Monthly Income:
    Source:

  • Vehicle

    Vehicle Interested In

    Tell us what you are looking for:
    Your Down Payment:

    Trade-In Vehicle

    Describe Your Trade:

  • Additional Info

    Banking Information

    Checking Bank Name:






     


  • Submit

    Check this box to state that the applicant (and each co-applicant) have read and accept the terms and conditions of this application.
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