Full Name:

Your Email Address:

Home Phone:

Secondary Phone:

Cell Phone:

Street Address:

City:

State:

Zip Code:

Driver's License #:

Social Security Number:

Date of Birth:

Employer:

Occupation:

Gross Monthly Income:

Time on Job:

New Field

Employer Phone:

Employer Address:

City:

State:

City:

Zip:

Other Income Source:

Monthly Gross Amount:

Additional Comments:

   
Privacy Policy Agreement:
(Please accept before submitting application.)
**** MUST READ AND ACCEPT **** In connection with your transaction, Charlies Cars may acquire information about you as described in this notice, which we handle as stated in this notice. 1.) We collect nonpublic personal information about you from the following sources: - Information we receive from you on applications or other forms; - Information about your transaction with us; and, - Information we receive from a consumer reporting 3.) We do not disclose, nor do we reserve the right to disclose, and nonpublic personal information about our customers, customer or former customers to anyone, except as permitted by law. We may disclose non-public personal information about you, as a consumer, customer or former, to non-affiliated third parties as permitted by law. 4.) We may, in addition, collect nonpublic personal information about you from the following sources: 4.) We restrict access to nonpublic personal information about you to those employees who need to know that information to provide products or services to you. If necessary to provide you with requested products or services, we may also allow this information to be accessed by ______________________ . We maintain physical, electronic, and procedural safegaurds that comply with the federal regulations to guard your nonpublic personal information.