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Full Name Street Address City ST Zip Social Security Number Date of Birth Present Employer Length Of Employment Previous Employer Length Of Employment Monthly Income # of Dependents Year, Make and Model of Vechicle Purchace Price You may fill out this form here. Once all of the blanks are filled in click the print button. The form will be printed to your printer. For security reasons we ask that you fax this page to us. Our Fax number is 706-376-0046. If you have any questions or concerns you may call us at 706-376-4000. I allow Starfleet Auto Sales to obtain a copy of my credit history and attempt to locate financing on my behalf. Signature____________________________________ Date___________________________