CREDIT APPLICATION

Please fill in the information below so that we may pre-approved your financing. We keep your personal and financial information confidential. Please read the below disclaimer and read our privacy policy for any questions regarding the use of the information submitted with this form. *Fields marked with an asterisk are required.

MULTI-STATE APPLICATION - A credit report may be obtained in connection with your application. IMPORTANT NOTICE: To obtain a copy of the Credit Acceptance Corporation Privacy Policy, please call toll-free 877-288-6357.

*Type of Application Joint applicants must complete and submit separate applications.

Dealership Lot #

Select One Individual Applicant Joint Applicant

*Email Address

*Home Phone

Cell Phone

Other Phone

*Last Name/M.I.

*First Name

Optional:

Maiden Name

*Social Security Number

*Date of Birth

Mr. Mrs. Miss. Dr.

/  /

*Street Number

*Street Name

Apt.#

*City

*State

*Zip Code

Select One 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

*Years at Residence

*Own or Rent?

*Monthly Payment

*Landlord Name

*Landlord Phone

Select One Own Rent

$

PRIMARY EMPLOYMENT

*Employer Name

*Occupation

*Street Number & Name

*Phone Number

*City

*State

*Zip Code

*Supervisor

*Monthly Income

*Pay Frequency

*Years On Job

$

None Daily Weekly Bi-Weekly Monthly Annual Quarterly Semi-Annually Semi-Monthly

SECONDARY EMPLOYMENT (OR PREVIOUS EMPLOYER)

*Employer Name

*Occupation

Street Number & Name

Phone Number

City

State

Zip Code

Supervisor

Monthly Income

Pay Frequency

Years On Job

$

None Daily Weekly Bi-Weekly Monthly Annual Quarterly Semi-Annually Semi-Monthly

OTHER INCOME

**Other Income Source

Amount And Frequency Of Other Income

**Alimondy, 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.

BANK INFO

*Savings Account

*Checking Account

*Is Check Direct Deposit?

Select One Yes No

Select One Yes No

Select One Yes No

*Name of Bank

*Location

I acknowledge that pursuant to the Fair Credit Reporting Act, my application will be submitted to Credit Acceptance Corporation, a Michigan corporation, and/or any of its affiliates or subsidiaries or divisions ("Credit Acceptance") for review in connection with the assignment of a sales finance contract written, or to be written, in connection with my purchase. I certify that the above information is complete and accurate. In connection with this application, I authorize and give Seller and Credit Acceptance my consent to obtain my credit report from any Credit Reporting Agency and complete an investigation of my credit and employment history and release information about my credit experience with Seller and/or Credit Acceptance. If and after my contract is assigned to Credit Acceptance, I also authorize and give consent to Credit Acceptance to obtain my credit report from any Credit Reporting Angency at any time during the term of my contract for any purpose whatsoever, including but not limited to for prescreening, as defined and permitted from time to time by the Federal Trade Commission; for reviewing my contract; to defer or extend my payments or due date under my contract; to take collection action on my contract; or for other legitimate purpose associated with my contract. I understand and acknowledge that Credit Acceptance will retain this application whether or not its approved. I also understand and acknowledge that if I ask, I will be informed if a credit report has been requested in connection with this application for credit, and the name and address of the Credit Reporting Agency that furnished the report. *Email and Cellular Communication Consent: By submitting this form via the submit button below, I authorize and give consent to Credit Acceptance to use the email address cellular telephone numbers I have provided on this application or which Credit Acceptance obtains to communicate with me for any purpose whatsoever, including but not limited to communication regarding my account activity, status and to collect any debt obligation I owe to Credit Acceptance. This authorization includeds consent for Credit Acceptance to make calls to any of my current or future cellular telephone numbers using any automatic telephone dialing systems or artificial or prerecorded voice. Spousal Consent: By signing below I authorize and give consent to Credit Acceptance to discuss my accoun with my spouse, if applicable, including discussing my account activity, status or payment arrangments.

I Authorize the verification of my credit.

SUMBIT