Buyer Information (Please fill out completely)
Full Name
Date of Birth SS# Email Address
Street Address Apt
Number
State and Zip
City How long at this address YR MO
Home Phone(with area code) Business Phone
Own or Rent Monthly
Payment
Occupation
Employed By Time Employed YR MO
Previous if less then 3 years at present
employer
 
Time Employed YR MO
Employer's Phone Number Total Monthly Gross Income*
(Before taxes and deductions)
Reference #1 Phone        
Address Relationship
Reference #2 Phone
Address Relationship
Reference #3 Phone
Address Relationship
Privacy Notice:
In accordance with federal regulations, we are giving you this Privacy Notice to tell you how we may use your non-public and personal information (Private Information) about you or your account. This Privacy Notice applies whether you are our current or former customer. This Privacy Notice does not amend or alter our obligations under any applicable state, local, federal law or ordinances.

I/we certify that the information provided on this application is in the best of my/our knowledge, complete and accurate. I/we understand that the dealer and financial institution(s) will rely on this information to judge my/our credit worthiness, and will retain this application and information about me/us whether or not this application is approved. Further, I/we authorize an investigation of my/our credit and employment history. I/we authorize the lender to release information about its experience with me/us. I/we understand that false statements may subject me/us to criminal penalties.
FAIR CREDIT REPORTING DISCLOSURE: This application for credit may be submitted by the Dealer to various financial institutions.We may disclose all the above information to different financial institutions with which we have joint marketing agreements with in regards to this application.
We may disclose all private information about you with non affiliated third parties as permitted by law. By signing below and submitting I / we acknowledge the receipt of this Privacy Notice and agree that all the above information given on this application is True, Complete and accurate.

Signature _________________________ Date ____/____/____


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