PERSONAL
INFORMATION
*First
Name:
*Last
Name:
* Date
of Birth:
* Driver's
License Number:
* Address:
* City:
* State:
* Zip:
Phone:
How
many years at this address :
Previous
Address:
How
many years at this address:
EMPLOYMENT
and INCOME:
Employer:
Occupation/Title:
Employer
Address:
Employer
Phone:
How
many years:
Current
Monthly Salary/Wage:
Previous
Employer:
How
many years:
Previous
Employer Address:
Other
monthly income:
Name
of Bank:
Click
all that apply:
Checking
Monthly
Mortage/Rent:
ADDITIONAL
INFORMATION:Please
take a few moments
to answer the following
questions so that
we may better assess
your finance needs.
How
much down payment do you have
right now?
What
is the maximum payment you can
make?
Are
you currently employed?
Yes
How
Are You Paid?
Company
Check
Can
you acquire full coverage insurance?
Yes
Do
You Have A Cell Phone Number
You'd Prefer We Call?
Do
You Have A Fax Number Where We
Can Fax You An Application?
The
following documents
will be required
to complete your
loan request:
Complete
Phone Bill (2)
Most Recent
Pay Stubs -
showing year
to date income Utility
Bill (7)
Verifiable
References
- Name, Address
and Phone Number Landlord
Information Full
Coverage Insurance
with no more
than $500 deductible Legitimate
Photo Identification, (Driver's License
or State I.D.)
OTHER:
Is
there anything you would like to tell us
about your financial history?:
What
are you interested in purchasing?:
*Confirm
Email Address (re-nter):
A SALES REPRESENTATIVE WILL CONTACT YOU TO OBTAIN OTHER NECESSARY INFORMATION
IN ORDER TO PROCESS YOUR APPLICATION.
How
should we contact you?:
Choose One:
by Phone
by Email
by Snail Mail
By
clicking 'Accept / Submit', below, you submit
and certify that all of the statements in this
application
are true and made for the purpose of obtaining
credit. You authorize us to begin a credit
investigation, including obtaining your consumer
credit report,
and to forward or allow direct electronic access,
your application to lenders, financial institutions,
or other third parties in order to process
your application. We the Dealer, may obtain
information
about you as described in this notice, which
we handle as stated in this privacy policy
notice. This does not apply to information
obtained in
a non-financial transaction. 1. We collect
nonpublic personal information about you from
the following
sources:· Information we receive from
you on applications or other forms in connection
with a financial transaction;· Information
about your transactions with us, our affiliates,
or others; and· Information we receive
from a consumer reporting agency. 2. We do
not sell customer or consumer information to
any
third party. We may disclose the information
we collect, as described above, to our affiliates,
to other financial institutions with whom we
have joint marketing agreements, or to companies
that perform services or functions on our behalf.
These companies may include financial service
providers and non-financial companies such
as computer and data processing companies,
and marketing
and aftermarket service providers. These companies
will be contractually obligated to keep the
information we provide them confidential and
to use the information
only to provide the services requested of them.
We observe limits and restrictions set by law
as to sharing of information with our affiliates
or others.3. We restrict access to nonpublic
personal information about you to those employees
who need to know that information to provide
products or services to you. We maintain physical,
electronic, and procedural safeguards that
comply with federal regulations to guard your
nonpublic
personal information.
Please
type in the random letters/digits you see
below to verify you are human and not a spambot. If you have trouble reading the letters, RELOAD THE IMAGE.
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Please
click "SUBMIT" ONCE and wait for
confirmation!
