PERSONAL INFORMATION
Fields marked with * (Asterisk) are mandatory.
Residence:
Previous Residence
(if time at current residence less than two years)
Financing Information
Employment Information
(if time at current residence less than two years)
Previous Employment
(if time at current residence less than two years)
Other Income / Other Income Source:
Alimony, child support, or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.
Additional Comments and Vehicle of Interest
Privacy Policy DISCLOSURE OF PRIVACY POLICY AND PRACTICES
In order to ensure the safeguarding of private customer information by financial institutions, the federal government enacted the Financial Services Modernization Act in 1999. We are considered a financial institution under the Act and provides this Notice to you as required by the Act. The purpose of this Notice is to explain what information about you the company wishes to receive from you and other parties, explain how and with whom the company may share this information and provide and option to you to exclude the sharing of certain information by the company under certain circumstances.
In order to facilitate your request of the company to provide the financing for the
ACKNOWLEDGMENT AND CONSENT:
I certify that the above information is complete and accurate to the best of my knowledge. Herein, the dealer and its associated creditor will collectively be referred to as, the creditor. I hereby, authorize the creditor to retain this application whether or not it is approved. The creditor may chose to rely on this application in deciding whether to grant the requested credit. False statements may subject me to criminal penalties. I authorize the creditor to obtain credit reports about me on an ongoing basis during this credit transaction, and to check my credit and employment history on an ongoing basis during the term of the credit transaction. I authorize the creditor to request credit reports and submit application to other creditors. If this application is approved, I give consent for the creditor to grant my credit information to its affiliates.