BUILDING RELATIONSHIPS ONE CUSTOMER AT A TIME

All fields listed in RED are necessary in order for the form to be sent.

Co-Applicant?

Personal Information

First Name

Middle Initial

Last Name

Suffix (if applicable)

Current Physical Address

City

State:

Zip Code

Mailing address, if different from physical address.

Home Phone

Cell Phone

Best Time to Call

Email Address

Social Sec. #

Date of Birth

Residence Information

Residence Type:

own
rent

Monthly Rent or Mortgage Amount?

Time at Current Residence

Landlord Name

Landlord Phone

Previous Address (include city, state, and zip code)

Time at Previous Address

Employment Information

Current Employer

Current Job Title

Time With Current Employer

Employer Phone

Monthly Income (net)

Pay Frequency:

Hourly Wage (If paid hourly)

Hours Worked Per Week

Previous Employer

Time With Previous Employer

Previous Job Title

Previous Monthly Income (net)

Other Income Information

Other Income (net amount, if any)

Frequency:

Source of Other Income

Banking Information

Name of Bank

Other? If so, explain

Checking?

Savings?

Credit History Information

Have you financed a vehicle before?

Have you ever had a vehicle repossessed?

Have you ever filed for bankruptcy?

Date of Bankruptcy (year is fine)

*If applicable* Who was your previous lienholder? When was your previous vehicle repossessed?

Driver's License Information

Do you Have a Drivers License:

Drivers License No.

Drivers License State:

Desired Vehicle Information

Do you have a Desired Vehicle on our lot?

If so, which vehicle?

Trade-In Information

Do you have a trade-in?

Year of vehicle

Make of vehicle

Model of vehicle

Payoff Amount (if applicable)

Do you have a clear title?

Other Information

Dollar amount available for Down Payment

How did you hear about us?

If you heard about us from a friend, let us know who!

Signature

I certify that the above information is complete and accurate. I authorize an investigation of my credit and employment history and the release of information about my credit experience with Auto Credit Line, Inc. to aide in approval of my application.

We do NOT share your personal, nonpublic information with nonaffiliated third parties except as permitted by law.

By submitting this application, I certify that all information is true and complete. I have read and fully understand the Privacy Disclaimer below. I authorize this auto dealer to retain this application, to check and verify my credit, employment and salary history. By using their website, I authorize them to provide reports on the status of my application, including information concerning whether I am approved for a loan, which lender's loan offer (if any) I choose to accept, whether my application for credit is denied, and whether I accept a loan from a lender.

Auto Credit Line Privacy Notice
WHAT DOES AUTO CREDIT LINE DO WITH YOUR PERSONAL INFORMATION?
Financial companies choose how they share your personal information. Federal law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do.

The types of personal information we collect and share depend on the product or service you have with us. This information can include:

Social Security number, Income
Payment History
Credit History
Credit Card or Other Debt, and Employment History.

When you are no longer our customer, we continue to share your information as described in this notice.

All financial companies need to share customers' personal information to run their everyday business. In the section below, we list the reasons financial companies can share their customers' personal information; the reasons Auto Credit Line chooses to share; and whether you can limit this sharing.

For our everyday business purposes -
such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus-
Yes we share this information; No You cannot limit this sharing

For our marketing purposes -
to offer our products and services to you- We don't share

For Joint marketing with other financial companies -
We don't share

For our affiliates' everyday business purposes -
information about your transactions and experiences - We don't share

For our affiliates' everyday business purposes -
information about your creditworthiness- We don't share

For our affiliates to market to you-
We don't share

For nonaffiliates to market to you-
We don't share

Who is providing this notice? Auto Credit Line

How does Auto Credit Line protect my personal information?
To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings.

How does Auto Credit Line collect my personal information?
We collect your personal information, for example, when you

give us your income information or provide employment information
give us your employment history or apply for financing
apply for a lease

Why can't I limit all sharing?
Federal law gives you the right to limit only

sharing for affiliates' everyday business purposes information about your creditworthiness
affiliates from using your information to market to you
sharing for nonaffiliates to market to you

State laws and individual companies may give you additional rights to limit sharing.

Affiliates
Companies related by common ownership or control. They can be financial and nonfinancial companies.