Financial Hardship Application COMPLETE THIS FORM IF YOU WANT TO APPLY FOR HARDSHIP. Please complete the financial hardship application in its entirety and attach all appropriate documentation in order to be considered for AFUSA’s financial hardship program. If the application is incomplete your financial request will be rejected. If there is a co-buyer on the account, the co-buyer must complete a separate Financial Hardship Application.Account Holder Name* First Last Account #* Last 4 of Social Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Cell PhoneWork PhoneVehicle VIN* Current Car Payment*Current Employer* Income Frequency*Select FrequencyUnemployedWeeklyBi-WeeklySemi-MonthlyMonthlyIncome per Check*Is there a Co-Buyer on account?* Yes No It is required that a form submission is completed on both buyers. Please have them complete the form as well to be considered. All applications may be rejected otherwise.Do you receive any other income?* Yes No Amount*How often?*Select FrequencyWeeklyBi-WeeklySemi-MonthlyMonthlyWhat type of payment arrangement are you looking to accomplish?*Are you receiving any income currently or in the near future?* Yes No From Whom?* How Much?*How often?*Select FrequencyWeeklyBi-WeeklySemi-MonthlyMonthlyDocumentation Drop files here or Select files Max. file size: 8 MB. Type of hardship?*Select Type of HardshipTerminationLayoffQuit JobHospital StayDivorceShort HoursOtherHave you filed for Unemployment?*ChooseYesNoI Cannot FileWhen did/will benefits start?* MM slash DD slash YYYY How Much?*Attach Documentation* Drop files here or Select files Max. file size: 8 MB. Please File Today!Why can you not file?*Explain Current Hardship*When did the hardship occur? (mm/dd/yyyy)* MM slash DD slash YYYY Upload any other supporting documentation to support your hardship Drop files here or Select files Max. file size: 8 MB. Example documentation would be a letter from your employer, your past two paystubs, proof unemployment has been filed, proof of unemployment benefits, divorce decree, or any other documentation related to your hardship that would help provide evidence of a hardship.* I agree to the terms and conditions of the E-Sign Disclosure and Consent.* I hereby acknowledge that the information given herein is true and correct. I authorize Auto Finance usa to verify any information contained in this application for the sole purpose of assessing financial need Δ