Hardship Request

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 State ZIP Code
Email*
Cell Phone
Work Phone
Vehicle VIN*
Current Car Payment*
Current Employer*
Income Frequency*
Income 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?*
What 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?*
Documentation
Drop files here or
Type of hardship?*
Have you filed for Unemployment?*
When did/will benefits start?*
Date Format: MM slash DD slash YYYY
How Much?*
Attach Documentation*
Drop files here or
Please File Today!
Why can you not file?*
Explain Current Hardship*
When did the hardship occur? (mm/dd/yyyy)*
Date Format: MM slash DD slash YYYY
Upload any other supporting documentation to support your hardship
Drop files here or
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