HORNE Customer Statement  
First Name
Last Name
Address (P.O. Box)
Address Physical
City
US States
Zip
Phone Number
SS #
Date of Birth
Employed
 Yes  No
Name of Company
Employed Since (Current Job)
Phone (Work)
Gross Pay Per Month
Other Sources of Income
Own or Rent Home
 Own  Rent
Monthly Payment
Time at Current Residence
Optional Information  
Do You Have A Trade?
 Yes  No
Year, Make, Model, Miles
Available Cash for Down Payment
Would You Like To Schedule An Appoinment
 Yes  No  Please Call Me
Date & Time  
Co-Buyer
 Yes  No
Name
Last Name
Social Security Co-Buyer
Date of Birth Co-Buyer
Employed
 Yes  No
Name of Company
Time at Current Job
Phone (Work)
Gross Pay Per Month
Other Sources of Income
Time at Current Residence
Horne Motors of Show Low; Permissions  
By Submitting this form, you have given Horne Motors of Show Low and their companies approval to check your credit, and to obtain financing on your behalf. All said information shall be kept confidential.