Hardship Request – Auto Finance USA

Financial Hardship Application

"*" indicates required fields

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

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

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

From Whom?*

How Much?*

How often?*

Documentation

Drop files here or

Max. file size: 64 MB.

Type of hardship?*

Have you filed for Unemployment?*

When did/will benefits start?*

How Much?*

Attach Documentation*

Drop files here or

Max. file size: 64 MB.

Why can you not file?*

Please File Today!

Explain Current Hardship*

When did the hardship occur? (mm/dd/yyyy)*

Upload any other supporting documentation to support your hardship

Drop files here or

Max. file size: 64 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.