Credit Application

RELIANCE FORD Financial Privacy Disclaimer
In connection with your transaction, we may obtain information about you as described in this notice, which we handle as stated in this notice.

1. We collect nonpublic personal information about you from the following sources:

Information that we receive from you on applications or other forms
Information about your transaction with us, our affiliates or others; and
Information we receive from consumer 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 not make such disclosures about you as a consumer, customer, or former customer.

3. We may also disclose nonpublic personal information about you as a consumer, customer or former customer, to nonaffiliated third parties as permitted by law.

4. 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

APPLICANT INFO.  
First Name:
Middle Name:
Last Name:
Address:
City:
State:
Zip Code:
Home Phone: Preferred Contact:
Work Phone:
E-Mail Address:
SS#:
Date of Birth:
Residence Type:
Monthly Pymt:
Time at Residence: ( Months/Years )
Employer:
Time Employed:
Yearly Income:
CO-APPLICANT INFO.  
Co-App First Name:
Co-App Middle Name:
Co-App Last Name:
Co-App SS#:
Co-App Date of Birth:
Residence Type:
Monthly Pymt:
Time at Residence: ( Months/Years )
Employer:
Time Employed:
Yearly Income:
 

By submitting this credit application, I/we certify that the information provided on this application is, to the best of my/our knowledge, complete and accurate. I/we understand that the Dealer and financial institution(s) will rely on this information to judge my/our credit worthiness, and will retain this application and information about me/us whether or not this application is approved. Further, I/we authorize an investigation of my/our credit and employment history, in connection with which my/our credit report(s) may be obtained from one or more consumer reporting agencies. I/we understand that false statements may subject me/us to criminal penalties. I/we further understand that the Dealer and/or the financial institution(s) that evaluate my/our application may require additional information.

I/We understand and have read the dealers Privacy Policy.

I wish to Opt-In OR I wish to Opt-Out

Signature (initials)
 
Date
 

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