APPLICANT INFORMATION

First name: *

  

Middle name:

Last name: *

Date of birth: *

Phone numbers:

Social Security No.: *

Day: *

E-mail:

Evening:*

Address: *
Cell

City: *

  

State: *

Zip: *

How long at address: *

Years

Months

Housing Status:  
Monthly Rent or Mortgage  

Previous Address if less 2yrs:

  

City:

  

State:

Zip:

How long at address: *

Years

Months

EMPLOYMENT INFORMATION

Employer: *

  

Address:

  

City:

  

State:

Zip:

Occupation:

  

How long: *

Years

Months

Monthly Income: *

  

Previous Employer if less 2yrs:

  

Address:

Years

Previous Employer:

  

Address:

Years

CONTACT INFORMATION

Let us reserve a date and time that you can come in to talk about your new vehicle.

  

Best time to call:

 

Appointment desired:

  

Set appointment:

Appointment time:

Where did you hear about us?

Enter any additional comments here:

* Indicates Required Fields
 

** In order to qualify for one of our many credit programs, we'll need your social security number to run a credit check. If you proceed with the questions above and submit your information above by clicking on the 'submit' button, you are thereby giving your consent for our dealership to obtain a consumer credit report.

 

Privacy Statement

In accordance with federal regulations, we are giving you this Privacy Notice to tell you how we may use non-public personal information (Private Information) about you or your account. The kinds of Private Information we collect about you or your account are described below. This Privacy Notice applies whether you are our current or former customer.

Collection and Use of Private Information

We may collect the following kinds of Private Information about you from the following sources:

  • Information you provide on applications, forms, or other correspondence, such as your name address, social security number and income.
  • Information about your transactions with us or others, such as your account balance and payment history.
  • Information we receive from consumer reporting agencies, credit references, employers, insurance companies and insurance agencies, such as your credit history and creditworthiness, and information that we obtain to verify employment history or that insurance coverage is in force.

Disclosure of Private Information

We may disclose Private Information (described above) under the following circumstances:

  • To marketing Service Providers and Joint Marketing Partners. We may disclose all Private Information to companies that perform marketing services for us or to other financial institutions with which we have joint marketing agreements.
  • With Non-Affiliated Third Parties. We may disclose all Private Information about you with non-affiliated third parties as permitted by law.

Protection of Information

We restrict access to your Private Information to our employees and third parties who need to know that information in order to service your account. Additionally, we maintain physical, electronic, and procedural safeguards to protect your Private Information in a manner consistent with industry standards for similar companies. We will review our safeguards from time to time, and strive to maintain them in a manner consistent with federal regulations, if any, that may be in effect from time to time.

By submitting this Credit Application, you acknowledge receipt of this Privacy Notice.