MULTI-STATE APPLICATION - A credit report may be obtained in connection with your application.
IMPORTANT NOTICE: To obtain a copy of the Credit Acceptance Corp. Privacy, Plese call toll-free 877-288-6357

Please fill in the form below. A representative will get back to you ASAP.
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You also have the option of Printing this form and handwriting it (if you don't like to type - it would be alot to type!) and FAXing it to us at:1-419-625-7000.
  Applicant: Individual:      Joint:  
Customer Contact Information:
  Cell Phone:     HomePh:   Email:
Mr.      Mrs.:      Ms.:   Last Name:   Jr.      Sr.:      III.:  
Social Security #:  First Name:     MI: Maiden Name:
Date of Birth:   MM/DD/YYYY
Residence Address:
Street:  Apt.#: How Long at Address: Yrs.   Mos
Person who's name appears on Residence Utilities:  
City:     State:     Zip:  
Mailing Address if different from above:
Street:  Apt.#: City:     State:     Zip:  
   Own Rent   Monthly Pmt:  Landlord Name:  
   Address:    City:     State:   Landlord Phone #:  
Previous Address:
Street:  Apt.#: City:     State:     Zip:  
How Long at Previous:  
   Primary Employment:
Employer Name:     Dept. or Military Rank:    Occupation:  
Address:  City:     State:    Zip Code:  
Phone #:    Ext.  Supervisor:   Hire Date:   mm/dd/yyyy
Monthly Income Gross:    Pay Frequency:  Wk: Bi:   2wks:  Month:
Work Schedule Primary Work Hours (Pick One):  6:00am-3:00pm:  9:00am-6:00pm:  12:00pm-9:00pm:
                                                                           3:00pm-Midnight:  Midnight-9:00am:
   Secondary Employment  
Employer Name:     Years On Job:    Occupation:  
Address:  City:     State:    Zip Code:  
Phone #:    Ext.  Supervisor:   Hire Date:   mm/dd/yyyy
Monthly Income Gross:    Pay Frequency:  Wk: Bi:   2wks:  Month:
Work Schedule Secondary Work Hours (Pick One):  6:00am-3:00pm:  9:00am-6:00pm:  12:00pm-9:00pm:
                                                                              3:00pm-Midnight:  Midnight-9:00am:
   Previous Employer:  
Previous Employer:     Years On Job:  
Address:  City:     State:    Zip Code:  
   Other Income Source:  
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Other Income Source:     Amount:  Frequency:
   BANK INFORMATION:  
Savings Account:   Yes   No Acct. #:
Checking Account:   Yes   No Acct. #:
Name:     Location:  

                                                                   
Phil Steinle MotorCars
5215 Milan Rd.
Sandusky, OH 44870
Phone:419/625-0055