You may use your VISA, Mastercard or Discover cards

Please provide all of the requested information. You may depress the 'TAB' key to easily move from field to field. When you have completed the form, press the "submit" button to send your application to Motor Mart Motors for processing. Alternatively you can print this completed form and fax it to (608) 647-6516.

You may apply for individual or joint credit, but select only one of the following:

	Individual Credit - unmarried applicant. Complete "applicant" section only.
	Individual Credit - married applicant. If both you and your spouse are residents of Wisconsin, complete both the "applicant" and "spouse" sections. If you or your spouse are not a Wisconsin resident, complete only the "applicant" section.
	Joint Credit - with your spouse. Complete the "applicant" and "spouse" sections.
	Joint Credit - with another applicant or cosigner who is not your spouse. Each of you must complete a separate application. If both of you and your spouse are Wisconsin residents, include information about your spouse in the "spouse" section.

NOTICE TO MARRIED APPLICANT: No provision of a marital property agreement, a unilateral statement under Wis. Stat. Sec. 766.59 or a court decree under Wis. State. Sec. 766.70 adversely affects the interests of the credit company unless prior to the time the credit is extended, the credit company is furnished with a copy of the agreement, statement or decree, or has actual knowledge of the adverse provision when the obligation to the credit company is incurred.

APPLICANT'S INFORMATION

Call with Social Security Number to
608-647-3803 or 1-800-756-1746

Full Name:
Marital Status: ********* Please select one ********* Married Unmarried Legally Separated by court order
Date of Birth:
Home Phone :
Cell Phone :
Street Address:
Mailing Address (if different than street address):
City / State / Zip:
E-mail Address:
Name of nearest relative not living with you:
nearest relative's relationship to you:
nearest relative's phone:

Employer Name:
Employer's Phone :
Length of employment (years or months):
Previous employer (if under 2 years at present):
Length of previous employment (years or months):
Present monthly income from employer: Gross Net (after taxes)

NOTE: 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: per Month Year Source:
Other Income: per Month Year Source:

Financial Debts/Obligations:
List current debts/obligations for both applicant & spouse.

Mortgage Holder:	Balance:	Monthly Payment:
Landlord:		Monthly Payment:
#1 Automobile loan with:	Balance:	Monthly Payment:
#2 Automobile loan with:	Balance:	Monthly Payment:
Student Loan:	Balance:	Monthly Payment:
Credit Card: VisaMaster CardDiscoverAmerican ExpressOther	Balance:	Monthly Payment:
Credit Card: VisaMaster CardDiscoverAmerican ExpressOther	Balance:	Monthly Payment:
Credit Card: VisaMaster CardDiscoverAmerican ExpressOther	Balance:	Monthly Payment:
Credit Card: VisaMaster CardDiscoverAmerican ExpressOther	Balance:	Monthly Payment:
Credit Card: VisaMaster CardDiscoverAmerican ExpressOther	Balance:	Monthly Payment:
Other:	Balance:	Monthly Payment:
Other:	Balance:	Monthly Payment:
Other:	Balance:	Monthly Payment:
Co-signer for:	Balance:	Monthly Payment:
Co-signer for:	Balance:	Monthly Payment:

SPOUSE'S INFORMATION:

Full Name:
Date of Birth:
Home Phone :
Cell Phone :
Street Address:
Mailing Address (if different than street address):
City / State / Zip:
E-mail Address:
Name of nearest relative not living with you:
nearest relative's relationship to you:
nearest relative's phone :

Employer Name:
Employer's Phone :
Length of employment (years or months):
Previous employer (if under 2 years at present):
Length of previous employment (years or months):
Present monthly income from employer: Gross Net (after taxes)

NOTE: 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: per Month Year Source:
Other Income: per Month Year Source:

Enter additional information or comments, if any, here:

IMPORTANT CERTIFICATIONS: I/we certify that this information has been supplied truthfully, accurately and voluntarily, and therefore authorize Motor Mart Motors to investigate our creditworthiness, credit history and financial responsibility through any credit bureau or by any other reasonable means for consideration for the loan applied for hereon, or for any other service offered by Motor Mart Motors or its affiliates. The credit bureau may release information about its credit experience with me/us. This application does not constitute a contract for the extension of credit. I/we understand that it may be a Federal crime punishable by fine or imprisonment or both to knowingly make any false statements concerning any of the above facts, as applicable under the provisions of Title 18, United States Code, Section 1014.

_________________________________________________________
Applicant's Signature & Date

_________________________________________________________
Spouse's Signature & Date

COMPLETE THIS NEXT SECTION ONLY IF YOU ARE MARRIED AND
YOU ARE APPLYING FOR CREDIT SEPARATE FROM YOUR SPOUSE

I certify that the credit being applied for, if granted, will be incurred or obtained in the interest of the marriage or family. This statement is made in accordance with Wis. Stat. Sec. 766.55(1).

_________________________________________________________
Applicant's Signature & Date

IF THIS SECTION APPLIES, WE ARE REQUIRED BY WISCONSIN LAW
TO NOTIFY YOUR SPOUSE BY MAIL IF YOUR LOAN IS GRANTED.

After you have completed the loan application, please click on the "Submit" button below to send your request to Motor Mart, Inc. for processing. If you do not want to transmit your application via the Internet, you may complete the application on-line, print it, and mail it to us or fax it to us at (608) 647-6516.

If you want to transmit your application but you would like to keep a copy of it as well, please print this web page before you click on the "Submit" button.

Thank you!