Richland Auto Mart

If you want fast and easy financing then please fill out our financing form on the right.

Prefix:

First Name:

Middle Initial:

Last Name:

Social Security Number (123-45-6789):

Date of Birth (mm/dd/yyyy):

Home Address:

Home Address 2:

City, Town:

County:

State:

Zip Code:

Home Phone:

Work Phone:

Best Contact Time: Day Evening

By filling out this form you are stating:

Every statement I have made in this application is true and correct and has been made by me with the understanding that you will rely on it. I agree that if anything arises which changes any of the statements I have made. I will promptly tell you.
You may exchange information about me with others. You may request a credit report on me and if I ask you will tell me the name and address of the consumer reporting agency that furnished it. If you update, renew or extend my loan, you may request a new credit report without telling me.
NOTE: By signing this application, you will authorize both the dealer and the Lender, to whom your contract may be assigned, to check your credit.