First Name Last Name Email Phone Date of Birth SSN # Street Address 1 Street Address 2 Apt./Suite City State Florida Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Florida Zip Code Previous Street Address 1 (If Current Address Less Than 2 Years Previous Street Address 2 Previous Apt/Suite Previous City Previous State Florida Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Florida Previous Zip Code Housing Own Rent Living with Family Monthly Payments Length of Time at Current Residence Less than 1 year 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years Over 10 Years Less than 1 Year Employer Name Job Title/Position Length of Time at Current Employer Less than 1 year 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years Over 10 Years Less than 1 Year Employer Street Address 1 Employer Street Address 2 Employer Apt/Suite Employer City Employer State Florida Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Florida Employer Zip Code Employer Phone Number Annual Salary Additional Comments I Agree Terms & Conditions By clicking Submit, you certify that all of the statements in this application are true and accurate and are made for the purpose of pre-qualifying you for automotive credit. Actual financing with approved credit only. You further acknowledge that you have read and understand our Consumer Privacy Notice and Electronic Disclosure. You authorize Champion Auto Leasing, our agents, and/or third party lenders to (i) begin a credit investigation, including obtaining your consumer credit report from one or more credit reporting agencies, now and with any update, renewal, refinancing, modification, or extension of any credit transaction with you; (ii) forward or otherwise allow access to your application (including your credit report and any updates or additions) to potential lenders, financial institutions, or other third parties in order to process your application; (iii) store securely the information we collect for evaluation of your application and for use in making additional offers to you in the future; and (iv) contact you via mail, mobile or home phone, text, or email. To receive credit, you may be required to submit a further completed loan application to us or to a third-party lender. Send
