Financing Form | Xclusive Wheels And

First Name

Last Name

Street Address

City

Region/State/Province

Postal / Zip code

Phone

Social Security Number (# de seguro)

Date of Birth (Fecha de nacimiento)

Driver License # (Numero de Licencia y Estado)

Employer (Empleador)

Employer zip (Postal de empleador)

Employer City (Ciudad de Empleador)

State (Estado)

Employer Phone (Extencion/ Número de telefono de empleador)

Hire Date (Fecha de contratación)

Monthly income (Ingreso Mensual)

When are you paid (Cuando se le paga?)

Last Payday (Ultimo día de pago)

Next Payday (proximo día de pago)

Bank Name (Nombre de banco)

Routing # (número de ruta del Banco.)

Checking Account # (# de cuenta de cheques)

Date Opened (approximately) (aproximada fecha abierta)

Credit Card # (# de targeta de crédito)

Credit Card Expiration (Fecha de vencimiento de tarjeta)

Cardholders full name (Titular de la tarjeta)

Billing Address (Domicilio fiscal)

City

Region/State/Province

Postal / Zip code

Upload Image of Bank Card/Credit Card/ Imagen de tarjeta de crédito

Upload File

Upload supported file (Max 15MB)

Upload Image of Drivers License/ Imagen de licencia para conducir

Upload File

Upload supported file (Max 15MB)

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Application for the following companies: Acima, Greenwave, Snap Finance, Synchrony