Secure Finance Application

Statement of Consent

I certify that the information provided by me is correct. I also understand that you will be checking with credit reporting agencies. I authorize an investigation of my credit and employment history and the release of information about my credit experience.

Please initial below to indicate that you have received a copy of our Privacy Notice and agree to all of the above.

YOUR CREDIT APPLICATION IS GOING THROUGH A SECURE WEBSITE AND YOUR IDENTITY IS SAFE

Initial Here

Co-Applicant's Initial Here

Vehicle Information

Type

Condition

Year

Make

Model

Down Payment

Your Contact Information

Name As It Appears on Driver's License

First Name

Middle Name

Last Name

Driver's License

Work Phone

Residence Phone

E-mail

Social Security Number

Male / Female

Date of Birth

Marital Status

Spouse Name

Spouse Income

Physical Address Information

Physical Address

City

State

Zip

County

Housing Information

Do you Rent or Own your home, or other?

LandLord / Mortgage Holder

Rent / Mortgage Monthly Amount

Mortgage Balance

Time at Current Residence

Previous Residence (If less than 5 years at Current Residence...)

Address

City

State

Zip

How long at Previous Residence

Banking Information

Name Of Bank

Account Types

Name Of Bank

Account Types

Employer Information

Occupation

Employer Name

Employer Address

Employer City

Employer State

Employer Zip

Employer Phone

Salary (Annually Gross)

Time at Employer

Type of Employment

Other Income

Other Income Frequency

Previous Employer Information (If less than 2 years at Current Employer...)

Occupation

Employer Name

Employer Address

Employer City

Employer State

Employer Zip

Employer Phone

Salary (Annually Gross)

Time at Employer

Additional Comments

Please include any information that you feel may help us process your application.

Joint Applicant Contact Information

First Name

Middle Name

Last Name

Driver's License

Work Phone

Residence Phone

E-mail

Social Security Number

Date of Birth

Joint Physical Address Information

Physical Address

City

State

Zip

County

Joint Applicant Housing Information

Do you Rent or Own your home, or other?

LandLord / Mortgage Holder

Rent / Mortgage Monthly Amount

Time at Current Residence

Joint Applicant Previous Residence (If less than 5 years at Current Residence...)

Address

City

State

Zip

How long at Previous Residence

Joint Applicant Banking Information

Name Of Bank

Account Types

Name Of Bank

Account Types

Joint Applicant Employer Information

Occupation

Employer Name

Employer Address

Employer City

Employer State

Employer Zip

Employer Phone

Salary (Annually Gross)

Time at Employer

Other Income

Other Income Frequency

Joint Previous Employer Information (If less than 2 years at Current Employer...)

Occupation

Employer Name

Employer Address

Employer City

Employer State

Employer Zip

Employer Phone

Salary (Annually Gross)

Time at Employer

Joint Applicant Additional Comments

Please include any information that you feel may help us process your application.

References

Name

Phone

City

State

Name

Phone

City

State

Name

Phone

City

State

Name

Phone

City

State

Applicant Electronic Signature

Please provide your electronic signature below to indicate that you have received a copy of our Privacy Notice and agree to all of the above.

ELECTRONIC SIGNATURE CONSENT TO DO BUSINESS Please read this information carefully and retain this information for future reference Electronic Signatures. You are purchasing a vehicle which requires you to sign a series of forms which may include but are not limited to a buyer's order, a service contract, an insurance form and an odometer statement. This dealership is utilizing electronic signature technology to help make this transaction more convenient and secure. As a result, one or more of the forms required to purchase your vehicle may be eligible for electronic signature execution. Consent. By signing this consent form, you understand and agree that you intend to conduct business electronically and have your signature captured electronically to execute certain forms for this vehicle purchase only. For those forms that are eligible for electronic signature, you acknowledge that by signing your name on the electronic signature pad, you are indicating your intent to sign the applicable forms or documents and this constitutes your signature. For other forms that are not eligible for electronic signature, you will still be required to execute hard copy documents in pen. You will receive copies of all forms signed both electronically and signed in pen. Withdrawal of Consent. You have the right to withdraw your consent to do business electronically at any time during this vehicle purchase transaction. However, if you withdraw such consent during the purchase process, all electronic signatures and consents provided will be considered void and you may elect to proceed with the vehicle purchase using pen and paper signatures for all required documents.

Applicant Signature

Joint Applicant Signature