Contact Info

First Name*

Last Name*

Email Address*

Phone #*

Street Address*

Date of Birth*

Social Security #*

Address

City*

State*

Zip Code*

Date of Residency

This is the date you started living at your current residence

Rent or Own?

Monthly Payment/Rent

Individual or Joint Application?

Individual

Joint

Marital Status*

Employment info

Employer Name*

Employer Phone #

Occupation or Job Title

Date of Employment

If Less Than 2 Years, Previous Employer?

Time At Previous Employer? (If Applicable)

Monthly Income before Taxes

Other Income Source

Other Monthly Income Amount

Tell us about the vehicle you want

Year*

Make*

Model*

Trim

Price

Trade In?

yes

Salesperson Name

HOW WOULD YOU LIKE US TO CONTACT YOU?

Call

Text

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*

Comments

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In connection with your transaction, Newberry Family Auto 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 Newberry Family Auto 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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