Philpott Ford

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Contact Information

First Name
Last Name
Middle Initial

Email
Home Phone
Work Phone

Social Security Number
Date of Birth

Address Information

Street
Apartment
City
State
Zip Code

Do you rent or own your residence?
Landlord/Mortgage Holder
Rent/Mortgage Monthly Amount

Time at Current Residence yrs mos

Previous Residence
Previous Street
Previous Apartment
City
State
Zip Code

Employment Information

Place of Employment
Occupation
Business Phone
State

Time At Current Employer yrs mos

Gross Salary
Net Salary
Other Income

Previous Employer
Previous Occupation
Previous Employer Phone

Time At Previous Employer yrs mos

Banking Information

Name of Bank
Account Types
Name of Bank
Account Types

Lender
Monthly Payment
Total Debt

Length of Loan yrs mos

Comments

Co-Applicant section

Co-Applicant Information

First Name
Last Name
Middle Initial
Email

Home Phone
Work Phone
Social Security Number
Date of Birth

Apartment
Street
City
State
Zip Code

Co-Applicant Employment Information

Place of Employment
Occupation
Business Phone

Time At Current Employer yrs mos

Gross Salary
Net Salary
Other Income

Previous Employer
Previous Occupation
Previous Employer Phone

Time At Previous Employer yrs mos

Important Privacy Information

Privacy Statement

PRIVACY POLICY

In accordance with federal regulations, we are giving you this notice to tell you how we may use non-public personal information ("Private Information") about you. This notice applies to both current and former customers of [DealershipName].

Collection and Use of Private Information

We collect Private Information about you from the following sources:

Information we receive from you, such as information on application or other forms, which may include your name, address, social security number and income.
Information about your transactions with us, our affiliates, or others, such as your account balance and payment history.
Information we receive from consumer reporting agencies, such as your credit history and creditworthiness.

Disclosure of Private Information

We may disclose Private Information (described above) under the following circumstances:

1) To Marketing Service Providers
We may disclose all Private Information to companies that perform marketing services for us or to other financial institutions with which we may enter into joint marketing agreements. We may make such disclosures about you as a consumer, customer, or former customer.

2) Among Affiliates
Some of the Private Information described above may consist of information about your history of dealing with us or our Affiliates, such as identification information, account history and balances and payment history (which we refer to as "Transaction Information"). We may share Private Information that consists of Transaction information with our Affiliates. Our Affiliates include other automobile dealerships and financial companies. We do this to provide you with the products and services we and our Affiliates offer.

3) With Other Third Parties
In addition, we may share all Private Information about you as a consumer, customer, or former customer with other non-affiliated third parties, as permitted by law.

Protection of Information

We restrict access to non-public personal information about you to our employees who need this information to provide financial products or services to you. We will strive to maintain physical, electronic, and procedural safeguards that are consistent with federal standards to guard your Private Information.

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Sales: 866-453-6059

Finance Application

Co-Applicant section