Financing/Credit Verification Form

For your convenience, this very brief, online application authorizes Island Acura to perform a credit verification and begin determining your best financing options. Please complete all questions below and press the submit button. A representative will contact you shortly.

Note: Any information submitted here will be used only for the purposes of verifying your credit. Island Acura will not sell or distribute your personal information.
Your social security number:
(e.g., 555-55-5555)
Date of Birth:
First Name:
Middle Initial:
Last Name:
Address:
City:
State:
Zip:
E-mail:
Home phone:
(e.g., 203-555-5555)
Employer:
Work phone:
Best time to call you?
Age:
Do you have a valid driver's license?
May we check your credit report with a national credit bureau?
What is your current Annual income?: (e.g., $30,000)
How long have you been working at your current job? (years)
How long were you working at the job before your current one? (years)
What is your residential situation?
What are your monthly rental/mortgage payments?
How long have you lived at your current residence?
How long did you live at your last residence?
What is your bankruptcy history?
Any repossessions?
Do you have a trade-in vehicle?
What down payment do you expect to make?


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.

**I have read the above statement and accept the terms

**I have read the and accept the terms

This application is submitted through an unsecured e-mail format.
Although it is highly unlikely, any information transmitted in this form may be viewed by a third party.
Island Acura 3350 Sunrise Highway On Long Island Wantagh, NY 11793 Phone 516-679-5400
Send Email Contact Us Showroom Fax: 516-679-5435 Admin. Fax: 516-679-0065