Eckland Motors Quality Preowned Vehicles in Keokuk IA

1802 Main Street
Keokuk, Iowa 52632

Monday to Friday
8:30 - 6:00 P.M.
Saturday 9:00 - 4:00 P.M.

How Long?
Years
Months

Gross Monthly Salary

Former Employer Address

(Hold Control key to select both)

Acount Type

Name of Relative

Not living with You

Name of Relative Not living with You

Optional: Answer only if the applicant desires.

Alimony

Child Support

Seperate Maintenance

Under Court Order
Written agreement
Oral agreement

If there will be a Co-Applicant, or Guarantor, or answered yes to any of the question in the abow 2 rows Please complete the Co- Applicant Section.

Social Security Number

Gross Monthly Salary

Other Monthly Income (amount)

IMPORTANT: By clicking on the submit button at the bottom of this form you certify the following: The above statements are submitted for the purpose of obtaining credit and are certified to be true and correct. I / we authorize dealer, Mercantile Trust & Savings Bank (MTSB) and any finance company, bank, or other financial institution to which the deal or MTSB submits my/our application to investigate my/our credit and employment history, obtain credit reports, and release information about this credit experience with me/us as the law permits.

Online Loan Application
Please Fill out completely. You will be contacted once your information has been processed.
Last Name	First Name	Middle Initial	SSN	Date of Birth	No. Of Dependents	Marital Status
Home Address	City	State	Zip Code	Home Phone	How Long? Years Months	If less than 2 years former address required
Former Home Address	Former City	State	Zip	How Long? Years Months
Employed By	Position	Dept. or Badge No.		How Long? Years Months	If Less than 2 years former employer required.
Buiness Address	City	State	Zip Code	Business Phone		Gross Monthly Salary
Former Employer	Position	Years How long? Months	Former Employer Address
Name of my Bank	City	State	(Hold Control key to select both) Acount Type	Other Monthly income (excluding Alimony, Child Support or Seperate Maintenance) Source		Amount

Name of Relative Not living with You	Relationship	Relative's Address	City	State	Relatives Phone
Name of Relative Not living with You	Relationship	Relative's Address	City	State	Relative's Phone
Will there be a Co-Applicant?		Yes No	Will Applicant Rely on Income of Co-Applicant as a basis for Repayment of this loan?			Yes No
If you Plan to repay this loan using any of the income types to the right check the box next to they type of monthly payment and indicate the type of agreement in the next box.		Optional: Answer only if the applicant desires. Alimony Child Support Seperate Maintenance		Under Court Order Written agreement Oral agreement		Monthly Amount Received
If there will be a Co-Applicant, or Guarantor, or answered yes to any of the question in the abow 2 rows Please complete the Co- Applicant Section.
Co-Applicant	Gaurantor
Last Name	First Name	Initial	Date of Birth	Social Security Number		Gross Monthly Salary
Home Address	City	State	Zip Code	Home Phone	How long? Years Months	Own Rent
Employer	Position	Dept. or Badge#	Employer Address	City	State	Employer Phone
How Long? Years Months
Name of my Bank	City	State	Other Income (excludes Alimony, Child Support or Separate Maintenance)		Source	Other Monthly Income (amount)
If you Plan to repay this loan using any of the income types to the right check the box next to they type of monthly payment and indicate the type of agreement in the next box.		Optional: Answer only if the applicant desires. Alimony Child Support Separate Maintenance		Under Court Order Written agreement Oral Agreement	Monthly Amount Received
Name of Relative Not living with you	Relationship	Relative's Address	City	State	Relative's Phone
Name of Relative Not living with you	Relationship	Relative's Address	City	State	Relative's Phone
IMPORTANT: By clicking on the submit button at the bottom of this form you certify the following: The above statements are submitted for the purpose of obtaining credit and are certified to be true and correct. I / we authorize dealer, Mercantile Trust & Savings Bank (MTSB) and any finance company, bank, or other financial institution to which the deal or MTSB submits my/our application to investigate my/our credit and employment history, obtain credit reports, and release information about this credit experience with me/us as the law permits.