General Info

First Name*

Last Name*

Email Address*

Phone #*

Social Security #*

Date of Birth*

Residential Address Information

Street Address*

Address line 2

City*

State*

Zip Code*

Time at Current Residence (Years)*

Time at Current Residence (Months)*

Residence Type*

Monthly Rent/Mortgage*

Previous Address Information (If less than two years at current address)

Street Address

Address Line 2

City

State

Zip Code

Time at Residence (Years)

Time at Residence (Months)

Residence Type

Monthly Rent/Mortgate

Employment info

Employment Status*

Occupation / Job Title*

Employer Name*

Employer Phone #*

Gross Monthly Income*

Additional Income

Time at Current Employment (Years)*

Time at Current Employment (Months)*

Previous Employment Info (If Less than two Years at current employer)

Occupation / Job Title

Employer Name

Employer Phone #

Gross Monthly Income

Additional Income

Time at Previous Employment (Years)

Time at Previous Employment (Months)

Your Loan

Year*

Make*

Model*

Loan Amount Requested*

Down Payment

Loan Term (In Months)

Do you have a vehicle to trade in?

Yes

Year

Make

Model

Miles

VIN Number

Special Instructions

Please note any special time or range of times which you desire us to contact you. We can contact you at any time during our regular business hours.

HOW WOULD YOU LIKE US TO CONTACT YOU?

Call

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I agree to give permission for the above applicant(s) Consumer Credit Report(s) to be obtained, at no cost to me, in order to help determine the types and extent of financing which are available*

In connection with your transaction, Nachbar Automotive may acquire information about you as described in this notice, which we handle as stated in this notice.

We may collect personally identifiable information such as name, postal address, telephone number, e-mail address, social security number, date of birth, etc. This personal information is collected and used by Nachbar Automotive Credit Application staff for the purpose of facilitating a relationship or business transaction.

Our website resides behind a firewall and uses SSL (Secure Sockets Layer, the industry-standard security protocol used to communicate with browsers) to transmit personal information. Data is strongly encrypted during transmission to ensure that personal and payment information is secure. Industry-standard data encryption techniques are used to protect personal information.

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