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MA
MB
MI
MN
MS
MO
MT
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NE
NH
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NM
NS
NT
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NV
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MA
MB
MI
MN
MS
MO
MT
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ND
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NH
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NS
NT
NU
NV
NY
OH
OK
ON
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KS
KY
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MD
MA
MB
MI
MN
MS
MO
MT
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NH
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NL
NM
NS
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NV
NY
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OK
ON
OR
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Employer:
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Address 2:
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HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MB
MI
MN
MS
MO
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
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PR
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SD
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Employer:
Employer Type:
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City:
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CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MB
MI
MN
MS
MO
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
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PE
PR
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SC
SD
SK
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7 Years
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CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MB
MI
MN
MS
MO
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
QC
RI
SC
SD
SK
TN
TX
UT
VT
VA
WA
WV
WI
WY
YT
Zip:
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AR
BC
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MB
MI
MN
MS
MO
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
QC
RI
SC
SD
SK
TN
TX
UT
VT
VA
WA
WV
WI
WY
YT
Drivers License Exp:
Mobile Phone:
Home Phone:
Email:
Time at Residence:
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3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12+ Years
Months:
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2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
Residence Type:
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Own
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Other
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Co-Buyer Previous Residence
Complete if you've been at your current Residence for less than 2 years.
Address 1:
Address 2:
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State:
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AK
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AR
BC
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MB
MI
MN
MS
MO
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
QC
RI
SC
SD
SK
TN
TX
UT
VT
VA
WA
WV
WI
WY
YT
Zip:
Phone Number:
Time at Residence:
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3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12+ Years
Months:
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2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
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FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MB
MI
MN
MS
MO
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
QC
RI
SC
SD
SK
TN
TX
UT
VT
VA
WA
WV
WI
WY
YT
Zip:
Phone Number:
Time at Residence:
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1 Years
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12+ Years
Months:
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1 Months
2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
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AR
BC
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MB
MI
MN
MS
MO
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
QC
RI
SC
SD
SK
TN
TX
UT
VT
VA
WA
WV
WI
WY
YT
Zip:
Phone Number:
Time at Residence:
Years:
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1 Years
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12+ Years
Months:
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1 Months
2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
Residence Type:
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Address 1:
Address 2:
City:
State:
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AK
AZ
AR
BC
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MB
MI
MN
MS
MO
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
QC
RI
SC
SD
SK
TN
TX
UT
VT
VA
WA
WV
WI
WY
YT
Zip:
Phone Number:
Time at Residence:
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2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12+ Years
Months:
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2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
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Own
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Other
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Employer:
Employer Type:
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Temporary
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Self-Employed
Cash Income
Monthly Income:
Occupation:
Address 1:
Address 2:
City:
State:
AB
AL
AK
AZ
AR
BC
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MB
MI
MN
MS
MO
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
QC
RI
SC
SD
SK
TN
TX
UT
VT
VA
WA
WV
WI
WY
YT
Zip:
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3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12+ Years
Months:
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2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
Co-Buyer Previous Employer
Complete if you've been at your current Employment for less than 2 years.
Employer:
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Cash Income
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CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MB
MI
MN
MS
MO
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
QC
RI
SC
SD
SK
TN
TX
UT
VT
VA
WA
WV
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6 Years
7 Years
8 Years
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5 Months
6 Months
7 Months
8 Months
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Employer:
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City:
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CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MB
MI
MN
MS
MO
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
QC
RI
SC
SD
SK
TN
TX
UT
VT
VA
WA
WV
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2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
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2021 Volkswagen Passat SE Gray FWD Automatic Sedan 2.0L Gasoline 11735 4 Cylinders - 11735
2021 Honda Pilot EXL 4WD White AWD Automatic SUV 3.5L Gasoline 11748 6 Cylinders - 11748
2021 GMC Terrain SLE AWD Black AWD Automatic SUV 1.5L Gasoline 11661 4 Cylinders - 11661
2020 Subaru WRX Limited 6M White AWD CVT Sedan 2.0L Gasoline 11695 4 Cylinders - 11695
2020 Hyundai Palisade SEL Gray FWD Automatic SUV 3.8L Gasoline 11737 6 Cylinders - 11737
2020 Honda Accord EX-L CVT Black FWD CVT Sedan 1.5L Gasoline 11701 4 Cylinders - 11701
2020 Dodge Durango R/T Black RWD Automatic SUV 5.7L Gasoline 11728 8 Cylinders - 11728
2020 Dodge Charger R/T Red RWD Automatic Sedan 5.7L Gasoline 11724 8 Cylinders - 11724
2019 Mazda MAZDA3 Preferred Hatchback Gray FWD Automatic Hatchback 2.5L Gasoline 11731 4 Cylinders - 11731
2019 Lincoln Nautilus Reserve Red FWD Automatic SUV 2.0L Gasoline 11738 4 Cylinders - 11738
2019 Jeep Wrangler Unlimited Sport White 4WD Automatic SUV 3.6L Gasoline 11734 6 Cylinders - 11734
2019 Dodge Durango GT 2WD Gray RWD Automatic SUV 3.6L Gasoline 11688 6 Cylinders - 11688
2019 Dodge Challenger R/T SCAT Pack Black RWD Manual Coupe 6.4L Gasoline 11647 8 Cylinders - 11647
2019 Chevrolet Malibu LT Silver FWD CVT Sedan 1.5L Gasoline 11742 4 Cylinders - 11742
2019 Cadillac Escalade Luxury 4WD Black 4WD Automatic SUV 6.2L Gasoline 11713 8 Cylinders - 11713
2018 Mazda MAZDA6 Touring 6A White FWD Automatic Sedan 2.5L Gasoline 11679 4 Cylinders - 11679
2018 Dodge Challenger SXT White RWD Automatic Coupe 3.6L Gasoline 11711 6 Cylinders - 11711
2018 Cadillac XT5 Premium Luxury Black FWD Automatic SUV 3.6L Gasoline 11743 6 Cylinders - 11743
2017 Hyundai Veloster Base 6MT Blue FWD Automatic Coupe 1.6L Gasoline 11600 4 Cylinders - 11600
2017 GMC Sierra 1500 Denali Crew Cab Long Box 2WD White RWD Automatic Truck 5.3L Gasoline 11739 8 Cylinders - 11739
2016 Mercedes-Benz E-Class E350 Sport Sedan Silver RWD Automatic Sedan 3.5L Gasoline 11740 6 Cylinders - 11740
2016 Mercedes-Benz CLA-Class CLA250 Black FWD Automatic Sedan 2.0L Gasoline 11715 4 Cylinders - 11715
2016 Chevrolet Silverado 2500HD LTZ Crew Cab 4WD Silver 4WD Automatic Truck 6.6L Diesel 11588 8 Cylinders - 11588
2016 Chevrolet Silverado 2500HD LT Crew Cab 4WD White 4WD Automatic Truck 6.6L Diesel 11680 8 Cylinders - 11680
2016 Chevrolet Impala LT White FWD Automatic Sedan 3.6L Gasoline 11617 6 Cylinders - 11617
2015 Jeep Cherokee Limited FWD Gray FWD Automatic SUV 2.4L Gasoline 11730 4 Cylinders - 11730
2015 Ford F-150 XL SuperCrew 5.5-ft. Bed 4WD Black 4WD Automatic Truck 3.5L Gasoline 11690 6 Cylinders - 11690
2014 RAM 3500 ST Crew Cab LWB 4WD DRW Black 4WD Automatic Truck 6.7L Diesel 11649 6 Cylinders - 11649
2014 Mazda MAZDA3 I Grand Touring AT 4-Door White FWD Automatic Sedan 2.0L Gasoline 11697 4 Cylinders - 11697
2014 GMC Sierra 2500HD Denali Crew Cab 4WD White 4WD Automatic Truck 6.6L Diesel 11691 8 Cylinders - 11691
2014 GMC Acadia Denali FWD White FWD Automatic SUV 3.6L Gasoline 11729 6 Cylinders - 11729
2013 Ford F-250 SD King Ranch Crew Cab 4WD White 4WD Automatic Truck 6.7L Diesel 11712 8 Cylinders - 11712
2012 Ford F-350 SD XL Crew Cab Long Bed DRW 4WD Black 4WD Automatic Truck 6.7L Diesel 11644 8 Cylinders - 11644
2011 Volvo S80 3.2 FWD Black FWD Automatic Sedan 3.2L Gasoline 11633 6 Cylinders - 11633
2011 Hyundai Equus Signature TAN RWD Automatic Sedan 4.6L Gasoline 11741 8 Cylinders - 11741
2010 Ford Fusion S Red FWD Automatic Sedan 2.5L Gasoline 11638 4 Cylinders - 11638
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ACKNOWLEDGMENT AND CONSENT:
I certify that the above information is complete and accurate to the best of my knowledge. Creditors receiving this application will retain the application whether or not it is approved. Creditors may rely on this application in deciding whether to grant the requested credit. False statements may subject me to criminal penalties. I authorize the creditors to obtain credit reports about me on an ongoing basis during this credit transaction and to check my credit and employment history on an ongoing basis during the term of the credit transaction. If this application is approved, I authorize the creditor to give credit information about me to its affiliates.
ACKNOWLEDGMENT AND CONSENT:
By checking this box I hereby consent to receive customer care text messages and/or phone calls from or on behalf of Roman Motor Company or their employees to the mobile phone number I provided above. By opting in, I understand that message and data rates may apply. This acknowledgement constitutes my written consent to receive text messages to my cell phone and phone calls, including communications sent using an auto-dialer or pre-recorded message. You may withdraw your consent at any time by texting "STOP" or "HELP" for help. See our https://romanmotorcompany.com/privacy for more information.
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ACKNOWLEDGMENT AND CONSENT:
By checking this box I hereby consent to receive customer care text messages and/or phone calls from or on behalf of Roman Motor Company or their employees to the mobile phone number I provided above. By opting in, I understand that message and data rates may apply. This acknowledgement constitutes my written consent to receive text messages to my cell phone and phone calls, including communications sent using an auto-dialer or pre-recorded message. You may withdraw your consent at any time by texting "STOP" or "HELP" for help. See our https://romanmotorcompany.com/privacy for more information.