| APPLICANT INFORMATION |
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Name: ________________________________________________________________________________________________________________ Last Name First Name M.I. |
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Date
of Birth: |
SSN
#: / / |
Home
Phone: Cell
Phone: |
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Current
Address: City: State: Zip:
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□
Own □ Rent # of Yrs. Monthly Payment: |
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Previous
address (if less than 2 years): |
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Landlord
Name:
Landlord Phone #: |
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| Employment Information |
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Employer
Name: |
Phone
#: |
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Position: |
Length
of Employment: |
Gross
Income before taxes: _________
per week _________ per month |
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Previous
Employer (if less than 2 years): |
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| CO-BUYER INFORMATION |
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Name: ________________________________________________________________________________________________________________ Last Name First
Name
M.I. |
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Date
of Birth: |
SSN
#: / / |
Home
Phone: Cell
Phone: |
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Current
Address:
City: State: Zip:
|
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|
□
Own □ Rent # of Yrs. Monthly Payment: |
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|
Previous
address (if less than 2 years): |
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Landlord
Name: Landlord
Phone #: |
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| Employment Information |
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Employer
Name: |
Phone
#: |
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Position: |
Length
of Employment: |
Gross
Income before taxes: _________
per week _________ per month |
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Previous
Employer (if less than 2 years): |
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This application will be submitted to various lenders
in order for Dealer Financial Services (DFS) to obtain financing on
your behalf. Privacy Notice: At
DFS protecting your privacy is very important to us. We want you to understand what information
we collect and how we use it. We
collect and use “non-public personal information” in order to provide
our customers with a broad range of financial products and services
as effectively and conveniently as possible. This does not apply to
information obtained in a non-financial transaction.
We treat non-public personal information in accordance with our
Privacy Policy. We may collect non-public personal information
about you from the following sources:
-
Information
we receive from you on applications or other form, in connection with
a financial transaction.
-
Information
about your transactions with us, our affiliates or other, and
-
Information
we receive from non-affiliated third parties, including Consumer Reporting
Agencies. “Non-public personal information” is non-public about
you that we obtain in connection with providing a financial product
or service to you. We do not
disclose nor do we reserve the right to disclose any non-public personal
information about our consumers, customers or former customers to non-affiliated
or third parties without your express consent, except as permitted by
law. We may disclose the non-public information
we collect, as described above, to persons, lenders or companies that
perform service on our behalf. We
restrict access to your non-public personal information and only allow
disclosers to persons and companies as permitted by law to assist in
providing products or service to you.
We maintain physical, electronic and procedurals safeguards to
protect your non-public personal information. Applicant Acknowledgement: I acknowledge that I received a copy of this
notice on the date below.
___________________________________________________________________
________________________________________________________________ Applicant Signature
Co-Buyer Signature
Date: _________________________________________ Date: _________________________________________
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