When you have completed the application below, print it by clicking your browser's print button, or by selecting the file menu's print command. Then, sign the application and take it to KELLY FORD for processing. Our friendly sales staff can assist you, answer any questions you may have, and provide you with the results of your application.

Will you be applying for credit alone or with another person?
(Primary applicant and joint applicant must complete separate forms)
Primary Applicant
Joint Applicant

If Joint Applicant, Relationship to Primary Applicant:
Married Parent Other

Last Name: Junior Senior
First Name: Middle Initial:
Number of Dependents:
Applicant's Date of Birth: Month: Day: Year: Age:
Present Address (Number and Street):
City: State: Florida Zip:
Phone in Applicant's Home? Yes No
Phone Number: (Area Code) () -
Own Home Outright Buying Home
Living With Relatives Leasing/Renting Own/Buying Mobile Home
How long have you lived in your present location?: Years: Mos:
Name of Landlord or Mortgage Holder:
Address of Landlord or Mortgage Holder:
City: State: Zip:
Rent or Mortgage Payment: $ per month
Previous Address (If less than 2 years at present address):
Street:
City: State: Zip:
How long did you live in your previous location? Years: Mos:
Level of Education (for those applicants under age 27 only):
4 Year College Graduate 2 Year College Graduate Special Training
Some College
High School Graduate? Yes No
Current Employer Name:
Current Employer Address:
City: State: Zip:
Applicant's Occupation (if military, state rank):
How long have you worked for this employer? Years: Mos:
Work Phone Number: () -
Gross Salary: $ Weekly Monthly Yearly
Social Security Number: - -

*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.
*Source of Other Income:
*Other Income: $ Weekly Monthly Yearly
Previous Employer's Name (If less than 5 years at current employer):

Previous Employer's Address:
City: State: Zip:
How long did you work for this employer? Years:
Name of Bank:
Checking & Savings Checking Only Savings Only No Account
Have You Ever Filed Bankruptcy? No Yes If Yes, When? Month: Year:
Is Applicant Obligated to Make Alimony, Child Support or Separate Maintenance Payments?
No Yes
If Yes, Amount to Be Paid per Month is: $

Special Notices

• For the purpose of securing credit from you, I certify that the above information is true and complete to the best of my knowledge. I further certify that I have attained The Age of Majority.
  
• I authorize you to check my credit and employment history and to provide and/or obtain information about credit experiences with me.

WARNING: Falsification of your identification is fraud and will be prosecuted to the fullest extent of the law.

I acknowledge that I have read and understand the disclosures.

Signature: _________________________________ Date: __________

Send this Application to Kelly Ford Just enter your email address
From:

For Dealer's Use Only:

Dealer Name: KELLY FORD
Offering # ____________________
Application Type: ____ RETAIL ____ RCL ____ OTHER

(1) Cash Price/Cap Cost (Incl. tax, title, reg. fees) $ ___________ (1)
(2) Down Payment/Cap Cost Reduction:

Cash $ _________ + Rebate $ _________= $ ___________ (A)
Trade Allow. $ ___________ - Owed $ ___________ = $ ___________ (B)
Total of Line (2) (A+B) $ ___________ (2)
(3) Unpaid Balance/Acquisition Cost (1-2)______________________(3)
If RCL: MSRP $ ___________ /LEV $ ___________
(4) Payable in ___________ Mo. Installments of $ ___________ (4)

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___ New ___ Used Year: _____ Make: ___________ Model: ___________
Body Style (If used vehicle): ___________ Used Car Miles: _______________
Vehicle Identification Number: ____________________
Stock #: ______________
Optional Equipment (If used vehicle): ____ Air ____ P/S ____ P/B ____ Auto Trans.
Other: _________________________
Trade: Year: ___________ Make: ___________ Model: ___________
Body Style: ___________

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Thank you for completing the Ford Credit Internet Application For Kelly Ford.