Patterson Auto Center

315 Central Expressway E
Wichita Falls, TX 76301
Phone: 940-761-3402
Fax: 940-761-1856

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Type of Application:

Type of Application:Single
Joint

Applicant Information

First Name *

Middle Initial

Last Name *

Suffix

S.S.N. *

Date of Birth *

Cell Phone

Home Phone

Present Address *

Present City *

County *

Present State *

Present ZIP *

Email *

Housing Information

Length of Residence *

Housing Status *

Mortgage/Rent Amount *

Landlord or Mortgage Holder *

Previous Address *

Previous City *

Previous State *

Previous ZIP *

Employment Information

Employer *

Occupation/Title *

Employer Phone *

Gross Monthly Income (Before Taxes, Insurance, etc) *

Time Employed (Years/Months) *

Previous Employer (If employed less than 3 years at current Employer) *

Previous Occupation/Title *

Previous Employer's Phone

Previous Time Employed *

Co-Applicant Information

First Name

Middle Initial

Last Name

Suffix

Social Security Number

Date of Birth

Cell Phone

Home Phone

Address

City

County

State

ZIP

Your Current Auto Loan

Make/Model

Current Payment

Financed With

Signature & Privacy Statement

Signature (Type Name Here) *

Date *

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