Tri-City Motors Inc.


*Name
*Social Security
*Birth date
*(If less than two years please fill out previous address)

*Home Phone
Daytime Phone
*(If less than two years please fill out previous employer information)

*Monthly Income
Type of Vehicle Desired: Make, Model, Year
Down payment $
Monthly Payment Desired
Trade IN	yes no
If yes, please select vehicle make, model and year
* Yes, I authorize Tri-City Motors to check my credit report.
No, I do not authorize Tri-City Motors to check my credit report.
* Email Address
Preferred Method of contact