Please take a few moments to accurately fill out this application, making sure to fill in all the required fields (marked with *).

SECTION A: INFORMATION REGARDING APPLICANT

Applicant Information

Attorney Information

Additional Information

* Which option are you more interested in?

		1. Keeping Your Car
		2. Getting a Different Car
		3. Exploring All of Your Vehicle Options

Address	City	State	Zip Code	Years	Months

Employer Name	Employer Phone	Job Description	Years	Months

* Check One	Hourly  |  Salary  |  Self Employed/Commission Only
* Check One	Part Time  |  Full Time
* Income per month (before taxes)		/ month
Do you receive an additional monthly bonus and/or Commission?   Yes |  No / month
Other Income   /month		Source
* Buying or renting current residence?     Renting |  Buying
* Monthly rent or first mortgage payment
* If buying your home, are you current on your payments?     Yes |  No
*Mortgage Company
*Do you have a second mortgage? Yes |  No
If yes, what is the monthly payment?

SECTION B: INFORMATION REGARDING JOINT APPLICATION OR OTHER PARTY (If necessary)

* Will there be a joint applicant? Yes |  No

SECTION C: ADDITIONAL QUESTIONS (Answer Yes/No and explain if necessary)

* All Are Required

1. Have you filed bankruptcy in the past 10 years? (choose yes if converting from a Chapter 13)     Yes |  No

2. Have you had any vehicles repossessed in the past 10 years?     Yes |  No

3. Is U.S. Bank listed in this bankruptcy as a creditor?     Yes |  No

4. Is there a 2nd lien on your current vehicle?     Yes |  No

5. Is there a Co-Signer on your current Vehicle loan?     Yes |  No    If yes, who?

6. Is there anyone else on the title of your current vehicle?     Yes |  No    If yes, who?

SECTION D: VEHICLE INFORMATION (not necessary if applying for a replacement vehicle)

* Owners (Name(s) on Title)

* Year * Make * Model * Vehicle ID Number (VIN) * Miles * Color

Vehicles Features Vehicle Condition     Yes No       Yes No Cruise Control     T Tops   Theft Deterent     Sunroof   ABS Brakes     Pwr Sunroof   Tilt Wheel     AM/FM   Pwr Windows     Tape/CD   Pwr Seats     Automatic   Pwr Door Locks     4-Speed   Leather Int     5-Speed   Air Conditioning     4 x 4   Other Items      G O O D F A I R P O O R       G O O D F A I R P O O R Grill     Left Fender   Front Bumper     Left Door(s)   Hood     Left Qtr Panel   Right Fender     Interior   Right Door(s)     Engine   Right Qtr Panel     Transmission   Lights     Brakes   Rear Bumper     Paint Finish   Roof     Tires   Other Notes

* Is this a leased vehicle? Yes |  No * What is your current monthly payment on this vehicle? * Number of payments remaining on this vehicle? * Name of creditor you make your payments to for this vehicle?

For any additional concerns or requests, please comment:

By entering my name above, I certify that the above information is true and correct to the best of my knowledge. I authorize 722 Redemption Funding Inc., to gather any necessary credit information on my behalf, including obtaining a credit report, for the sole purpose of determining credit worthiness. I also authorize 722 Redemption Funding Inc. to share this information with the automobile dealerships it deems necessary, for consideration as to whether it meets credit requirements with respect to the financing of my vehicle purchase in the case of a replacement loan, or refinance in the case of a redemption loan. I authorize 722 Redemption Funding Inc. to contact my present and past employer(s) to verify the information I have provided regarding my employment and income. I authorize 722 Redemption Funding Inc. to contact my landlord(s) or mortgage holder(s) to confirm the information I have provided regarding my residence(s). If an attorney at law is currently representing me in a bankruptcy proceeding, I authorize 722 Redemption Funding Inc. to exchange with this attorney information regarding my bankruptcy proceeding and all aspects of this application for credit, including without limitation my employment, income and debts, my vehicle(s) and my residence, as well as any other private non-public information deemed necessary by 722 Redemption Funding Inc., or my attorney, in order to perform for me the services I have requested of them. Furthermore, I certify that I have read, understand and accept this website's privacy and terms policy.