Financing Request

Credit Application

Complete this single-page application to request vehicle-financing assistance. It asks for sensitive personal information, so use a private device and review our Privacy Notice before submitting.

Fields marked with an asterisk are required. Your information will be used only for the financing request described in the authorization below.

Personal Information

First Name

Last Name

Cell Phone

Date of Birth

Social Security Number

Nine digits. Your entry is masked unless you choose Show SSN.

Driver's License

Issuing State

License Number

Upload Driver's License / ID

JPG or PNG still images only: no more than 10 megapixels and no more than 6000 pixels wide or high. PDFs: no more than 4 pages. All uploads: 10 MiB maximum. Drop a file here or choose one.

Residential History

Present Address

Apartment / Suite / Unit

City

State

ZIP Code

Housing Status

Monthly Rent / Mortgage

Years at Address

Months at Address

Employment Information

Employer Name

Title / Position

Employer Phone

Monthly Gross Income

Employer Address

City

State

ZIP Code

Years Employed

Months Employed

Representative

Choose Your Rep

Authorization

Draft for business/dealer review before production use.

I request and authorize Hollywood Auto Mart to submit this application to selected dealers and prospective financing sources solely to evaluate and arrange the requested vehicle financing. I authorize Hollywood Auto Mart, those selected dealers, and those prospective financing sources to obtain and use my consumer reports solely for that purpose. I certify that the information in this application is true, accurate, and complete to the best of my knowledge, and I authorize verification only as permitted by law for this financing request.

I acknowledge that the Privacy Notice is available to download or print.

Type Your Full Legal Name