Financing Pre-qualification form

Loan Information

* Amount Required:	* Loan Term: Choose A Term 36 Months 48 Months 60 Months 72 Months
* Down Payment:	* Trade-in: Yes No

Desired Vehicle

Make:
Model:
Year:
VIN Number:

Employment Information

*Employer:
*Occupation:
*Monthly Income:
*Time on Job:	Years 1 Year 2 Years 3 Years 4 Years 5 Years More than 5 years
*Business Phone:
*Address:
City:
State:	Zip:

Other Income

Source:
Monthly Income:

Contact Information

*Name:
*Email:
*Home Phone:	*Day Phone:
Fax:	Preferred Contact: Phone MorningPhone MiddayPhone EveningEmailFax
*Address:
City:
State:	Zip:

Applicant Information

*Soc. Sec. No.:
*Date of Birth	MM DD YY
*Residence Type:	OwnRent
*Monthly Payment:
*Time at Residence:	Years 1 Year 2 Years 3 Years 4 Years 5 Years More than 5 Years

Additional Information

Message Text:

Gramm-Leach Bliley Act Privacy Notice You are hereby notified that this dealership in connection with your transaction, may obtain information about you as described in this notice. We will handle this information privately, but in order to process your transaction this information may be disclosed to third parties as provided by law.

1. We collect personal information about you from the following sources:
   • Information we recieve from you on credit and insurance applications, from our website and other forms;
   • Information about your transactions with us, our affiliates, or others; and
   • Information about you we my receive from a credit reporting agency.
2. We may disclose all of the information we collect, as described above, to companies that perform marketing services on our behalf or to other financial institutions with whom we have joint marketing agreements. We may make such disclosures about you as a consumer, a customer, or as a former customer.
3. We may also disclose nonpublic personal information about you as a consumer, customer, or former customer to non-affiliated third parties as permitted by law.
4. At this dealership we restrict access to nonpublic personal information about you only to those employees who need to know that information in order to provide products or services to you. In accord with this policy, we maintain physical, electronic and other procedural safefuards to guard your nonpublic personal information inside our dealership.
   By clicking "Agree & Send Request", customer acknowledges receipt of this Notice on this date.

* These fields are required

By clicking "send", you certify that all of the above information is correct and that submitting this form authorizes us to obtain credit reports and check your credit history.