Online Credit Application

Please fill out all fields marked with an asterisk* as completely as possible.

Personal Information

Email Address

Name

First Name

Last Name

Social Security Number

Birthdate

YYYY

Cell Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Type of Residence

Years at Address

Monthly Payment

Employment Information

Current Employer

Business Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Employer Phone Number

(###)

###

####

Years You've Been Employed

Position/Title

Gross Annual Income

Other Annual Income

Source of Other Income

Previous Employer (If less than 2 years at current position)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Self-employed

Attn To:

Terms & Conditions Disclosure

By clicking "SUBMIT", 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 your application to lenders, financial institutions, or other third parties in order to process your application. We the Auto Dealer, may obtain information about you as described in this notice, which we handle as stated in our website privacy policy notice. If we are required to provide you our official company privacy policy, it will be given to you in person, by mail or if you consent to receive it electronically, by e-mail. This does not apply to information obtained in a non-financial transaction. All applicants must satisfy all lender criteria in order to obtain credit. Not all applicants, including pre-approved applicants, will qualify for a loan.By completing and submitting your request, you consent to having all legally required disclosures, notices, privacy policies and information ("Disclosures") provided or made available to you in electronic form and to doing business with us electronically.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. 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. 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. Consent to Terms & Privacy Policy Our company takes your privacy seriously and is committed to safeguarding your privacy online. By clicking "SUBMIT", you accept the Terms, Conditions and Disclosures above and have read and accept the terms of the Privacy Policy.

Online Credit Application

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Leasing Office•5809 Avenue N, Brooklyn, NY 11234•Phone 718.676.7406