Vehicle Information

VehicleStock Number

Contact Information

First Name *Last Name *Email *Phone *

Personal Information

Date of Birth *Social Security Number *Driver's License Number *Driver's License State *

Residence Information

Address *City *State *ZIP / Postal Code *Residence Status *Monthly Rent / Mortgage *Time at Residence *

Previous Address

Address *City *State *ZIP / Postal Code *

Employment Information

Employer *Employer City *Employer State *Work Phone *Position *Length of Employment *

Gross Monthly Income *Other Monthly IncomeOther Income Source

Previous Employer

Employer *Employer City *Employer State *Work Phone *Position *Length of Employment *

Are you applying with a co-applicant?

YesNo

Personal Information

First Name *Last Name *Email *Phone *Date of Birth *Social Security Number *Driver's License Number *Driver's License State *

Residence Information

Address *City *State *ZIP / Postal Code *Residence Status *Monthly Rent / Mortgage *Time at Residence *

Previous Address

Address *City *State *ZIP / Postal Code *

Employment Information

Employer *Employer City *Employer State *Work Phone *Position *Length of Employment *

Gross Monthly Income *Other Monthly IncomeOther Income Source

Previous Employer

Employer *Employer City *Employer State *Work Phone *Position *Length of Employment *

Additional Comments

Read Privacy Notice

Privacy Notice

In connection with your transaction, the dealership may obtain information about you as described in this notice.

1. We collect nonpublic personal information about you from the following sources: Information we receive from you on applications or other forms; Information about your transactions with us, our affiliates or others; and, Information we receive from consumer reporting agency (e.g., credit bureau).

2. We may disclose all of the information we collect, as described above, to companies that perform marketing services on our behalf or to financial institutions with whom we have joint marketing agreements. We may make such disclosures about you as a consumer, customer, or former customer.

3. We may also disclose nonpublic personal information about you as a customer, customer for former customer to non-affiliated third parties as permitted by law.

4. We restrict access to nonpublic personal information about you to those dealership personnel who need to know that information in order to determine your eligibility for products and services, and to provide you with products and services, and to those who are subject to confidentiality provisions and restrictions that prohibit use of information beyond the performance of specified services. To guard your nonpublic personal information we maintain physical, electronic, and procedural safeguards that comply with federal standards.

By submitting this application, you represent that all information in the form is accurate and complete to the best of your knowledge. You are also confirming that you are competent to enter into contracts and that no bankruptcy proceedings are in progress or anticipated which involve you. Please note that credit is granted based on scores, payment history, assets, etc. and the decision is that of the bank, not us. We may retain this application whether or not credit is granted. You agree to pay all fees in connection with your loan. You authorize us to obtain information from others concerning your credit standing and other relevant information impacting on this application. Your electronic signature confirms you understand our policies, terms and conditions and grants us permission to commence your loan.

I /WE HAVE READ AND UNDERSTAND THE DEALER’S POLICIES, TERMS, AND CONDITIONS. I / WE HEREBY CERTIFY THAT ALL OF THE INFORMATION ON THIS APPLICATION AND ALL STATEMENTS MADE HEREIN ARE TRUE AND CORRECT AND THAT I/WE AM/ARE THE PERSON(S) ON THE APPLICATION AND NOT A MISREPRESENTATION. THE INFORMATION IS SUBMITTED FOR THE PURPOSES OF OBTAINING CREDIT AND AUTHORIZES THE DEALER TO MAKE SUCH INQUIRIES AS ARE NECESSARY TO OBTAIN CREDIT INFORMATION AND AUTHORIZE MY BANK, SUPPLIERS, AND CREDIT REFERENCES TO RELEASE INFORMATION REGARDING MY ACCOUNT(S).

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2015 Dodge Laramie 1500 – Langley – 19676A