Apply For a Loan Form

Customer Information

Email Address*:		State*:
First Name*		Zip Code*:
Last Name*:		Home Phone*:
Middle Initial:		Cell Phone:
Street*:		Social Security #*:
Apartment:		Date of Birth*:
City*:

Employment Information

Place of Employment*:		Zip Code*:
Occupation*:		Business Phone:
Street*:		Length of Employment:
Suite/Apartment:		Net Salary:
City*:		Other Income:
State*:		Other Income:
		Gross Salary*:

Housing Information

Landlord/Mortgage Holder:
Rent/Mortgage Monthly Amount*:
Time at Current Residence*:
Previous Residence (if less than years years at current residence)
Previous Landlord Name:
Previous Landlord Phone:
Street:
Apartment:
City:
State:
Zip Code:

Banking Information

Name of Bank:

Account Types:

Current Loan Information

Lender:
Monthly Payment:
Total Debt:
Length of Loan:

Vehicle of Interest

Make:
Model:
Stock Number:
Amount of Cash Down:

Important Privacy Information

Introduction

Here at Extreme we want to ensure your private information is only seen by us, and only shared with those companies who are authorized either by yourself or as allowed or required by law. This document explains our privacy policy, it states why we ask for this type of information we do, and if we do reserve a right to share information with non-affiliated third parties, lets you "opt-out" of our reservation to do so. Please take a moment to read this entire document.

Collection of Information

The purchase of a motor vehicle requires considerable accumulation of nonpublic personal information. We may use this information to check your credit score with credit agencies or with references. Some of the information we obtain from you may be required by state of federal agencies, such as the Department of Motor Vehicles or the Internal Revenue Service. This information may be required even if you were to pay cash for your vehicle. Ex: We would need your driver's license or social security number.

Protecting Your Information

We safeguard nonpublic personal information according to established industry standards and procedures. We maintain physical and electronic safeguards that comply with state and federal law. We restrict access to nonpublic personal information about you to those employees and outside contractors who need to know the information to provide product or service to you. We prohibit our employees and agents from giving information about you to anyone in a manner that would violate any applicable law or our privacy policy. We also have what is called a SSL which certifies that allows us to have  128 bit encryption.
Information Sharing

Unless we have indicated our desire to share your nonpublic personal information with non-affiliated third parties (by checking the box in the section below), we share information:

A) As permitted by federal or state law.

B) For purposes of processing a sale or lease transaction as your request or authorize, such as submitting information to third party financial institutions that may be requested to take an assignment of the contract or verifying insurance coverage information.

C) When using outside service providers to help us provide you with products and services. Before providing information to our service providers we enter into contractual agreements prohibiting them from disclosing or using the information other than for the purpose it was disclosed.

D) With "Affiliated" companies. Companies that are affiliated with us include any company that controls us, any company we control, or any company under common control with us.

I am interested in leasing or purchasing a vehicle through Extreme cars and trucks and request that my Consumer Credit Report be obtained,
at no cost to me, in order to help determine what types and the extent of financing which may be available to me at this time.

I agree and accept these terms