Park Mazda of Wooster

Credit Application Form

The Ohio laws against discrimination require that all creditors make credit equally available to all credit-worthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civic Rights Commission administers compliance with this law.
Please fill out all required (marked by *) and applicable fields.
Last Name*
First Name*		Middle Initial
Date of Birth*
Present Address*
City*		State*
		Zip*
	Phone Number include area code*
	Cell Phone
	Living Arrangements*
How long have you lived at your current address?*
If you have lived in you residence less than two years please provide your previous address in the fields below
Address		City
State		Zip code
Name and address of Landlordholder
Name*
Address
City		State
How much is your monthly rent or mortage payment? $
Education and employment information
Level of education (age under 27 only)
	Current employers name*
Applicant's occupation (if military ,state rank)*
	Amount of time at your current job*
	Work phone number include area code*
If you have worked at your current job for less than two years please provide your previous information in the fields below
	Previous employers name
	Amount of time at your previous job
Previous Work phone number include area code
	Gross monthly salary*
	Other monthly income
Financial Information
Name of your bank*
	Types of bank accounts held
Creditor's Name and City/State
1. Creditor's name
Address:
City		State:
2. Creditor's name
Address:
City		State:
3. Creditor's name
Address:
City		State:
Authorization to process application
For the purpose of securing credit from you, I certify that the above statement is true and complete to the best of my knowledge. I further certify that I have attained the age of majority. I authorize you to check my credit and employment history and to provide and / or information about credit experience with me.
Check the box to the right if you agree with the statement above.		yes I agree with the above statement required
Your name*		Date*
	Your Social Security number*
	Your E-mail*
Privacy Notice In accordance with federal regulations, we are giving you this privacy notice to tell you how we may use non-pubic personal information ("Private Information") about you or your account. The kinds of Private Information we collect about you or your account are described below. This Privacy Notice is provided to you as required by federal laws and regulations applicable to our business. This Privacy Notice does not amend or alter our obligations under any applicable state or local laws, regulations or ordinances. Collections and Use of Private Information. We may collect the following kinds of Private Information about you from the following sources: Information you provide on applications, forms, or other correspondence, such as your name, address, social security number and income. Information about your transactions with us or other such as account balance and payment history. Information we receive from consumer reporting agencies, credit references, employers, insurance companies and insurance agencies, such as your credit history and creditworthiness, and information that we obtain to verify employment history or that insurance coverage is in force. Disclosure of Private Information We may disclose Private information (described above) under the following circumstances: To market Service Providers and Joint marketing Partners. We may disclose all Private information to companies that perform marketing services for us or to other financial institutions with which we have joint marketing agreements. With Non-affiliated third Parties. We may disclose all Private Information about you with non-affiliated third parties as permitted by law. Protection of Information. We restrict access to your private information to our employees and third parties who need to know that information in order to service your account. Additionally, we maintain physical, electronic, and procedural safeguards to protect your Private Information in a manner consistent with industry standards for similar companies. We will review our safeguards from time to time, and strive to maintain them in a manner consistent with federal regulations that may be in effect from time to time. By sending this application you acknowledge receipt of this Privacy Notice.