Apply Online

Galpin Ford LINCOLN Mazda works with a wide range of lending options to help you obtain the credit you need to purchase your next car, truck, or SUV, even if you have bad credit, no credit, or are a first time car buyer. Purchasing a new Ford, Mazda, or LINCOLN vehicle in Prescott, Dewey-Humboldt or in Prescott Valley, Sedona, Verde Valley and New River areas couldn't be easier with Galpin Ford LINCOLN Mazda working to get you the auto loan you need.

Don't let your bad credit history prevent you from getting the vehicle you need, making on-time payments on a new car loan you can effectively rebuild your credit. Take a moment and fill out our online finance application, or if you prefer, call us at 1-800-821-1093, one of our knowledgeable finance specialists will help you get the financing you need to get your next new or pre-owned vehicle.
   This page uses a secure connection to send information.
   fields are required.

Application Information

Application Information

Application Type:  
Type of application:  

If you are applying with a joint application, please have the cosigner complete the form after the primary applicant has hit Submit.  

Identification

Identification

First Name:  
Middle Initial  
Last Name:  
Date of Birth: Month  
Date of Birth: Day  
Date of Birth: Year  
Social Security Number:  

Contact Information

Contact Information

(Area Code) Daytime Phone:   (Area Code) Evening Phone:  
EMail:  
How would you like to be contacted?  

Address Information

Address Information

Address:   City:  
State:   Zip:  
How long at your current residence? Years   Months  
Do you rent or own?  
Mthly rent/mtg:  
Landlord or Mortgage Co:   Phone Number:  
If less than 2 years - please complete previous history information below.  
Previous Address:   Previous City  
Previous State:   Zip:  
How long at previous residence? Years   Months:  

Employment History

Employment History

Current Employer:   Gross Monthly Income (before taxes):  
Position/Occupation:   Phone:  
Address   City:  
State:   Zip:  
Job Length? Years   Months  

If less than 2 years - please complete previous history information below.  
Previous Employer:   Phone  
Address   City  
State   Zip:  
Previous Job Length? Years   Months:  

Previous Employer:   Phone:  
Address:   City:  
State:   Zip:  
Previous Job Length? Years   Months:  

Questionnaire

Questionnaire

Other Monthly Income - $:   Source of other income (disability, alimony, child support):  
Bank Name   Branch Office:  
Account Type:  
Education:  
Have you ever filed for bankruptcy?   If yes, when:  
Have you ever had a car or other merchandise repossessed?   If yes, when:  

Personal References:

Personal References:


Personal Reference   Relationship  
Address   City and State  
Zip:   Phone  

Personal Reference   Relationship:  
Address   City and State:  
Zip:   Phone:  

Personal Reference   Relationship:  
Address   City and State:  
Zip:   Phone:  

Credit Report Authorization

Credit Report Authorization

I certify that the information provided by me is correct. I also understand that you will be checking with credit reporting agencies. I authorize an investigation of my credit and employment history and the release of information about my credit experience. I have read and received a copy of your Privacy Notice and agree to all of the above.  

Credit Check:  
(Initial here) *required  

  • Approval based on lender criteria, Not all customers will qualify.
Read our privacy notice - which discloses the privacy practices for Galpin Ford LINCOLN Mercury Mazda. This privacy notice applies solely to information collected by this web site.
Site Map