CREDIT PRE-APPROVAL FORM
Complete the credit application below, sign, and fax it to us at 925-432-8932 or drop it by our office.
We'll call you back within 24 hours of our next sale with a response.

Year/Make/Model of Auto you are interested in Total you'd like to spend? Amount Down?

Applicant
Date Social Security # Birth Date Home Phone
Cell Phone

Last Name First Name Middle Initial

Current Address                                                     City                                                          State ZIP How long?
Previous Address                                                   City                                                          State ZIP How long?

Occupation                                                             Present Employer                                    Work # How long?
Previous Occupation                                             Previous Employer                                  Work # How long?

Applicant's Gross Monthly Income from Employment..................................$ _____________
Do you own a home Mortgage Payment Do you rent? Monthly Rent

Co-Applicant
Date Social Security # Birth Date Home Phone

Last Name First Name Middle Initial

Current Address                                                     City                                                          State ZIP How long?
Previous Address                                                   City                                                          State ZIP How long?

Occupation                                                             Present Employer                                    Work # How long?
Previous Occupation                                             Previous Employer                                  Work # How long?

Co-Applicant's Gross Monthly Income from Employment..................................$ _____________

I, the undersigned (1) make the above representations which are certified correct, for the purpose of securing credit, (2) authorize financial institutions to obtain consumer credit reports on me periodically and to gather employment history as they consider necessary and appropriate, (3) authorize your affiliates to obtain consumer credit reports on me, (4) authorize financial institutions, affiliates and others to exchange credit, account and financial information about me, and (5) understand that CCCPAA or any financial institution to whom it is submitted will retain this application whether or not it is approved, and that it is the applicant's responsibility to notify the creditor of any changes of name, address or employment.

X_______________________________________
Applicant's Signature

X_______________________________________
Co-Applicant's Signature

Contra Costa County Public Auto Auction Inc.
1501 Loveridge Road, Pittsburg, CA 94565, Tel. 925-432-8900, Fax 925-432-8932, E-mail info@cccpaa.com, Dealer #35228