Loan Information

Applicant Type:
* Amount Required: * Loan Term:
* Down Payment: Trade-In:

Vehicle Information

* Year: Miles:
* Make: VIN:
* Model:

Employment Information

* Employer:
* Occupation:
* Monthly Income:
* Time On Job:
* Business Phone:
Address:
City: State:
* Zip:

Other Income

Source: Monthly Income:

Contact Information

* First Name: * Last Name:
* Email: * Home Phone:
* Day Phone: Fax:
Cell Phone: Preferred Contact:
Address:
City: State: * ZIP Code:

Applicant Information

  Format: xxx-xx-xxxx   Format: MM/DD/YYYY
* Soc. Sec. No.: * Date of Birth:
* Residence Type: * Monthly Payment:
* Years At Residence:

Additional Information

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I certify that I have provided true and accurate information in this form. By submitting this form, I authorize the dealer to begin a credit investigation, to process by application, and to forward my application to lenders, financial institutions, or other third parties in order to process my application.


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Jack Demmer Automotive Group
21531 Michigan Ave
37300 Michigan Ave, Wayne
Dearborn, MI 48124
Phone: 313-274-8800
Email: Contact Us
Fax: 313-274-8811
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Jack Demmer Ford
37300 Michigan Ave
Wayne, MI 48184
Phone: 734-721-2600
Email: info@aplanheadquarters.com
Fax: 734-721-1831