Personal Info:

Name:

Street:

City:

State:

Zip Code:

How long at current address?

Phone number:

Cellphone number:

E-Mail:

Social Security Number:

Birthday (MONTH, DAY, YEAR):

Employment Info:

Current Employer:

Current Occupation:

Current Employer Phone:

Income:

Time employed (years/months):

Residence Info:

Own or Rent?
Own
Rent
Live with Family
Other

Your Preferred Deal:

Describe Your Ideal Vehicle:


Your Ideal Payment:
$

Amount You Can Put Down:
$

Applying for Credit:

In connection with your transaction, Endurance Automotive may obtain 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 transactions with us, our affiliates of other; and,
Information we receive from a consumer-reporting agency.

2. We may disclose all of the information we collect, to companies that perform marketing services on our behalf of to other financial institutions with whom we have joint marketing agreements. We may make such disclosures about you as a consumer, customer or former customer.

3. We may also disclose nonpublic personal information about you as a consumer, customer or former customer to non-affiliated third parties as permitted by law.

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. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.

Application Agreement:

The words "you," "your" and "yours" mean each person submitting this application. The words "we," "us," "our" and "ours" as used below refer to us, the dealer, and to the financial institution(s) selected to receive your application.

You authorize us to submit this application and any other application submitted in connection with the proposed transaction to the financial institutions disclosed to you by us the dealers. This application will be reviewed by such financial institutions on behalf of themselves and us the dealer. In addition, in accordance with the Fair Credit Reporting Act, you authorize that such financial institutions may submit your applications to other financial institutions.

You agree that we may obtain a consumer credit report periodically from one or more consumer reporting agencies (credit bureaus) in connection with the proposed transaction and any update, renewal, refinancing, modification or extension of that transaction. You also agree that we or any affiliate of ours may obtain one or more consumer credit reports on you at any time whatsoever. If you ask, you will be told whether a credit report was requested, and if so, the name and address of any credit bureau from which we or our affiliate obtained your credit report.

You agree that we may verify your employment, pay, assets and debts, and that anyone receiving a copy of this is authorized to provide us with such information. You further authorize us to gather whatever credit and employment history we consider necessary and appropriate in evaluating this application and any other applications submitted in connection with the proposed transaction.

We may keep this application and any other application submitted to us and information about you whether or not the application is approved. You certify that the information on the application and in any other application submitted to us, is true and complete. You understand that false statements may subject you to criminal penalties.

Signature:

I certify that I have read and understand the terms of this agreement
and that the information I’ve submitted is true and correct to the best of my knowledge:

Your Name:

Your application will be dated .