Dealer: Autos Unlimited Inc.
Contact: Leif Johnson
Phone: (412) 269-6699
Facsimile: (412) 262-2886

Today's Date:
(MM/DD/YYYY)

PERSONAL PROFILE
Last Name:

First Name:

Date of Birth:
(MM/DD/YYYY)

Social Security Number:
(XXX-XX-XXXX)

E-mail Address:
(required)

Current Street Address or PO Box:

City:

State:
-------------------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Minnesota Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code:

Work Phone Number: (required)
(XXX-XX-XXXX)

Home Phone Number: (required)
(XXX-XX-XXXX)

Cell Phone Number:
(XXX-XX-XXXX)

How long have you lived at the above mentioned address?

Do you Rent or Own?
Rent     Own

Rent or Mortgage paid per month:

VEHICLE INFORMATION
Make:

Model:

Preferred Year(s):

Transmission:
Automatic     5-Speed

Number of Doors:
(Press the CTRL Key to select multiple)
----------------- 2 Doors 3 Doors 4 Doors 5 or More

Preferred Color(s):

Any Other Preferences:

METHOD OF PAYMENT:

Will you be Trading In your Current Vehicle?
Yes     No

If Yes, then please provide some information about the vehicle in the box below:

Type of Payment(s) you are interested in:

Credit History:

Occupation:

Employer Name and Address:

Length of Time Employed:

Income:
per Hour per Week per Month per Year

Co-Signer Name:

Co-Signer Phone: