Farian Auto Sales
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828-368-0166
1135 US-70 Connelly Springs, NC 28612
Veteran Discount Honored
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Contact Information
Name
*
First
Last
Cell Phone
*
Date of Birth
Driver's License Number
Driver's License Issue Date
Email
*
Social Security Number (SSN)
*
Driver's License State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Driver's License Expiry Date
Residential Information
Income (copy) (SSN)
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Housing Type
*
--- Select Choice ---
Housing Type
Rent
Own
Other
Monthly Rent/ Mortgage Amount
*
Years at address (in months)
Employment Details
Employer Name
*
Monthly Gross Income
Title/Position
*
Years at Job
*
Employer Phone Number
*
Interrested Vehicle
Vehicle Make
e.g. Honda
Vehicle VIN
Vehicle Model
e.g. Accord
Down Payment Amount
Vehicle Year
e.g. 2020
Additional Comments
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