Application For Vehicle Financing During Chapter 13 Plan Form

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OFFICE OF THE STANDING CHAPTER 13 TRUSTEE
Mailing Address:
ALBERT RUSSO
Erik D. Collazo, Esq.
David A. Martin, Esq.
CN 4853
STANDING CHAPTER 13 TRUSTEE
Counsel
Trenton, NJ 08650
1 AAA Drive • Suite 101
Robbinsville, NJ 08691-1803
For Payments Only:
Voice 609-587-6888
PO Box 933
Fax 609-587-9676
Memphis, TN 38101-0933
APPLICATION FOR VEHICLE FINANCING DURING CHAPTER 13 PLAN
Complete ENTIRE form online in your web browser. Click the button at the bottom of the form to print it.
1.
Both debtors (if applicable) must sign the form.
Fax completed form and finance agreement to: 609-587-9676
2.
Chapter 13 Case Number: _________________
Debtor Name: ________________________________
Co-Debtor Name:_____________________________
1.
Vehicle Type
______________________ Year
________ Mileage ___________
(make and model)
(4 digits)
2.
Warranty?
Type of Warranty: ________________________________________
NO
3.
Purchase Price: _______________
4.
Monthly Payment: _______________
5.
Terms of Financing: __________ Months
6.
Interest Rate: __________
7.
Total Amount to be borrowed: _______________
8.
Total Finance Charges: _______________
NO
9.
Credit, Life or Disability Insurance?
Type of Insurance: ________________________
NO
10. Is a vehicle presently being paid OUTSIDE of the Chapter 13 Plan?
Type of Vehicle and Amount? ________________________________________
NO
11. Is a vehicle presently being paid THROUGH the Chapter 13 Plan?
Type of Vehicle and Amount? ________________________________________
The undersigned hereby applies for permission to obtain consumer credit during the pendency of his/her
Chapter 13 Case in order to purchase the vehicle described above which is necessary for his/her performance
under the confirmed plan. I certify that the information provided is true and accurate. I understand that I am
under no obligation to purchase a vehicle on credit; however, I am unable to obtain a vehicle otherwise.
Further, I understand that the approval of this transaction by the Standing Chapter 13 Trustee is neither a
recommendation nor an endorsement of the specific vehicle being purchased and the credit terms presented
and I/we assume all risks involved.
I authorize the Standing Chapter 13 Trustee to provide written information in regards to this application
and my Chapter 13 Case to the dealer/lender.
DATED: _______________
DEBTOR SIGNATURE: _____________________________
CO-DEBTOR SIGNATURE: __________________________
The application will be reviewed and either an approval letter or a denial letter will be issued in approximately
five (5) business days.
After completing the form, click here to print.

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