Buy Here Pay Here
Financing Application
Fill out this form to start the credit approval process.
All sensitive data is encrypted before transmission and is never sent as clear-text.

Special Financing Requirements Listed Below:
Bank Info:
Voided Check
Account & Routing Numbers
Savings Account Statement
Residence Info:
Utility Bill or Proof of Residency dated less than 30 days ago
Employment Info:
2 (Two) pay stubs dated less than 30 days ago
License Info:
A copy of your valid US Driver's License
Payment Info:
A Down Payment
(*) denotes required information
Personal informaton
First Name:
Middle Initial:
Last Name:
Daytime Phone:
- - *
Evening Phone:
- -
- -
Social Security Number:
Date of Birth:
Mortgage/Rent Payment:
Residence Type:
Time at Residence:
Time at Residence:
If you have lived at your current residence less than 5 years, please enter your prior address: :
List several accounts in your name:
Drivers License Number #:
Drivers License State:
Drivers License Expiration:
employment informaton
Employer Name:
Employer Address:
Employer City:
Employer State:
Employer Zip:
Employer Phone:
Employment Status:
Time on Job:
Time on Job:
Pay Period:
Pay Amount:
Other Income:
Per Month  
vehicle interested in
Vehicle Year:
Vehicle Make:
Vehicle Model:
Vehicle Mileage:
down payment
Do you have a Checking Account:
(If yes - enter name of bank)
Do you have a Savings Account:
(If yes - enter name of bank)
Down Payment:
trade-in information
Trade-In Year:
Trade-In Make:
Trade-In Model:
Trade-In Mileage:
Additional Comments:
agree & authorize
I agree that by submitting this application, I authorize and give this dealership, as well as any potential financing source this dealership presents this application to, my consent to obtain my credit report from any credit reporting agency used to complete an investigation of my credit.
Click To Add Co-Applicant Info
Submit application
November 18, 2018    

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Coastal Car Buyers, Inc.

2640 Portland Road
Arundel, Maine 04046
ph: 207-282-8600
fax: 207-282-8181

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