AMERICAN FIRST FINANCIAL

602-230-0900 Fax 602-532-7335

Loan Application Date: __________________

Last Name: ____________________________________ First: ____________________________ M: __________________________

Add: _______________________________________________________________Unit # _____________Parking Space# _________

City: _______________________________ State: ___________________ Zip: ______________________ How Long: ____________

County: ______________________ Nickname? ________________________________Live With: ____________________________

SS#: ________________________________ DOB: __________________________ Birth Place: ______________________________

DL#: ______________________________ Exp Date: ________________State: _________ Maiden Name: ______________________

Mailing Add: ____________________________________________________________City: ______________ Zip: _____________

Home Phone: _____________________________ Cell: _____________________________ Cell 2: __________________________

Work # _______________________________Ext: ______________ Mess/Contact #: ______________________________________

Email: ________________________________________________________________________Marital Status: _________________

Spouse/Partner Name: _______________________________________ DOB: __________________ SS#: ______________________

Prior Res: ________________________________________________________________________ Unit #: ___________________

City: ____________________________________State: _________________ Zip: ______________ How Long: _______________

Mothers Maiden: ________________________________________ Still Living: Y / N Phone: ______________________________

Father’s Name: _________________________________________ Still Living: Y / N Phone: ______________________________

Have you been arrested in the last 5 years? Y / N What for: ___________________________________________________________

Do you have a criminal record? Y / N Explain: _____________________________________________________________________

Have you ever filed or currently in bankruptcy? ____________________________________________________________________

Have you ever had an Auto Title Loan before? With who? ____________________________________________________________

How did you hear about our Company? (Circle) Yellow Pages: Verizon / Yellow Book / Qwest Dex / Referral / Drive By / TV / DMV

Radio / Sign / Repeat Customer / Print Ad / Internet / BBB / Other: ___________________________did you visit our web site? Y / N

Do you own or rent your home? ______________ Landlord or Mortgage Co. ____________________________________________

Phone #: ____________________________ Contact Person: ___________________________Mortgage Balance: $ _____________

Attend college or school? Y / N Where? _________________________________________________________________________

Where do you Bank? ____________________________Account Types: Checking / Savings / Credit Card? _____________________

Credit Card? Account #: _______________________________________________Exp. Date: __________Balance? $_____________

Do you have any outstanding loans? Y / N Explain: _________________________________________________________________

Payday or other Title Loans? Y / N with whom? ____________________________________________________________________

Page 1 of 3

Present Employer: _________________________________________________________________ Supervisor: ___________________

Address: _________________________________________________________________________ Phone: _____________________

City: ___________________________________State: __________ Zip: _____________________ How Long: ____________________

Occupation: _______________________________________________________ Earnings: $ ________________ Per: ______________

Work Schedule: ____________________________________________________________How many hours per week? ______________

Are You Self-Employed? Y / N Name: __________________________________Type Of Business: ____________________________

Income: $_____________________ Per: ___________________ Expenses: $__________________ Net: $_________________________

Have a Professional License? Y / N #_________________________State Lic. # ________________________City #: ________________

Major Supplier: _____________________________Add: ____________________________________Phone: _____________________

Major Customer: ____________________________ Add: ___________________________________Phone: _____________________

Previous Employer: _________________________________________________________________ Supervisor: __________________

Address: _________________________________________________________________________ Phone: _____________________

City: ___________________________________State: __________ Zip: _____________________ How Long: ____________________

Spouse Name: __________________________________________________________ Phone: ________________________________

SS#: ______________________________ DL#: ______________________________ Exp Date: ________________State: ___________

DOB: __________________________ Birth Place: _____________________________ Maiden Name: ___________________________

Mothers Maiden: ________________________________________ Still Living: Y / N Phone: _________________________________

Father’s Name: _________________________________________ Still Living: Y / N Phone: _________________________________

Present Employer: _________________________________________________________________ Supervisor: __________________

Address: _____________________________________________________________ Phone: _______________________Ext: _____

City: ___________________________________State: __________ Zip: _____________________ How Long: ____________________

Occupation: _______________________________________________________ Earnings: $ ________________ Per: _____________

Work Schedule: ____________________________________________________________How many hours per week? ______________

Insurance Co: ________________________________________________ Phone: _____________________Fax: _________________

Agent: _____________________________________________________ Phone: ______________________Fax: _________________

Address: ___________________________________________________City: __________________State: ________Zip: __________

Policy #: __________________________________________________________________ Full Coverage? Y / N Liability Only? Y / N

What is your collision deductible? $______________________Comprehensive deductible? $_______________________

Page 2 of 3

VIN: ________________________________________________

Year: ____________Make: ________________________Model: ______________________________Body: ______________________

Color: ________________Plate #: ____________________Tag Exp: __________________Mileage: _____________________________

Engine: ________________________ Transmission: Auto / Manual Additional Equipment: ____________________________________

List other vehicles you own:

Year: ____________Make: ________________________Model: ______________________________ Plate #: ____________________

Year: ____________Make: ________________________Model: ______________________________ Plate #: ____________________

*WE MUST HAVE FIVE REFERENCES COMPLETE WITH NAME, ADDRESS AND PHONE.

Name: _______________________________________________________________________Relationship: ____________________

Address: _____________________________________________________________________ Phone: ________________________

City: ___________________________________State: __________ Zip: _____________________ How Long: ___________________

Name: _______________________________________________________________________Relationship: ____________________

Address: _____________________________________________________________________ Phone: ________________________

City: ___________________________________State: __________ Zip: _____________________ How Long: ___________________

Name: _______________________________________________________________________Relationship: ____________________

Address: _____________________________________________________________________ Phone: ________________________

City: ___________________________________State: __________ Zip: _____________________ How Long: ___________________

Name: _______________________________________________________________________Relationship: ____________________

Address: _____________________________________________________________________ Phone: ________________________

City: ___________________________________State: __________ Zip: _____________________ How Long: ___________________

Name: _______________________________________________________________________Relationship: _____________________

Address: _____________________________________________________________________ Phone: _________________________

City: ___________________________________State: __________ Zip: _____________________ How Long: ____________________

I HEREBY CERTIFY UNDER PENALTY OF PERGURY THAT THE ABOVE INFORMATION IS TRUE AND CORRECT. I UNDERSTAND THAT MISREPRESENTATION TO A FINANCIAL INSTITUTION IS FRAUD AND VIOLATES STATE AND FEDERAL LAW. I AUTHORIZE AMERICAN FIRST FINANCIAL, LLC AND ANY AGENTS TO VERIFY ANY INFORMATION PROVIDED, OBTAIN CREDIT REPORTS AND ANY OTHER INFORMATION NESSESSARY FOR CREDIT EXTENSION.

Signature: ____________________________________________________________________Date: __________________________

Signature: ____________________________________________________________________Date: __________________________

Page 3 of 3

American First Financial PRIVACY NOTICE

NOTICE OF ALL YOUR FINANCIAL PRIVACY RIGHTS:

We respect the privacy of our customers and we are committed to treating customer information responsibly. We collect ‘non-public personal information’ about you from the following sources; 1) Information we receive from you on applications or other forms, 2) Information about your transactions with us, and 3) Information contained within credit reports we receive.

We do not disclose any non-public personal information about our customers or former customers to anyone, except as permitted by law. We restrict access to nonpublic personal information about you to those employees who need to know that information to provide products and services to you. We maintain physical, electronic, and procedural safeguards that comply with federal standards to guard your non-public personal information.

ACKNOWLEDGEMENT: I/We acknowledge that I/we have read and understand and have received a copy of this notice on the date indicated below:

X_____________________________________ X_________________________________________

Signature Date Signature Date

______________________________________ ___________________________________________

Name (printed) Name (printed)

Required Items

[ ] 1) Bring the vehicle that is being used as security for the loan, we have to see the vehicle. Vehicle must be in good condition.

[ ] 2) Extra set of keys (the key(s) must open the doors and start the ignition)

[ ] 3) Bring in Arizona Certificate of Title for the vehicle that is paid off, with your registration. You must owe no money on the vehicle.

[ ] 4)  Bring Insurance Documents. If loan is for more than $1,000. You must provide full coverage insurance coverage on the vehicle.

[ ] 5) Proof of Income: Provide most recent pay stubs or income statements and bank statements. You must have a gross income of at least $1,000.00 per month (or benefits income of at least $800.00 per month for any loan) 

[ ] 6) Provide utility bills showing proof of where you are living. Or Lease Agreement Or 5 recent pieces of mail delivered to you at your address.

[ ] 7) Identification 2-Forms You must be 18 years of age or older

[ ] 8) 5 Personal References close family and friends (name address and phone number)

[ ] 9) If you rent or own, the name address and phone number of your Landlord or Mortgage company. If you are renting bring your lease agreement.

When you have the items call 602-230-0900 for an appointment to come in to process the loan. You can fax your application in. 602-532-7335.

Email: titleloansUSA@yahoo.com

www.aztitleloans.com