Type of application:
Individual
Joint
Applicant type:
Primary applicant
Co-applicant
* First name: * Last name:
* DOB:
* EMail:
SSN:
(Optional. Form not secure.) * Current Address:
* City: * State:
Zip Code: * Home Phone:
* Work Phone: Cell Phone/Pager:
Do you rent or own?:
Buying
Renting
Live with Relative
* Monthly rent/mortgage:
* How long at this residence? * How long at prev. residence?
* Current Employer: * How long?
* Occupation * Previous Employer:
* How long? * Occupation
* Monthly Income (before taxes): $ Bank account:
Checking
Savings
Checking and Savings
None
Other Income: $ Source
Education
High School
Some College
2 Yr Degree
4 Yr Degree
More than 4 Yr
None
Have you ever filed for bankruptcy?
No
Yes
Yes - Discharged
Have you ever had a car or other merchandise repossessed?
No
Yes
Gramm-Leach Bliley Act Privacy Notice
You are hereby notified that this dealership in connection with your transaction, may obtain information about you as described in this notice. We will handle this information privately, but in order to process your transaction this information may be disclosed to third parties as provided by law.
We collect personal information about you from the following sources:
Information we receive from you on credit and insurance applications, from our website and other forms;
Information about your transactions with us, our affiliates, or others; and
Information about you we my receive from a credit reporting agency.
We may disclose all of the information we collect, as described above, to companies that perform marketing services on our behalf or to other financial institutions with whom we have joint marketing agreements. We may make such disclosures about you as a consumer, a customer, or as a former customer.
We may also disclose nonpublic personal information about you as a consumer, customer, or former customer to non-affiliated third parties as permitted by law.
At this dealership we restrict access to nonpublic personal information about you only to those employees who need to know that information in order to provide products or services to you. In accord with this policy, we maintain physical, electronic and other procedural safefuards to guard your nonpublic personal information inside our dealership.
