Contact Info

First Name*

Last Name*

Email Address*

Phone #*

Street Address*

Address line 2

City*

State*

Zip Code*

Social Security #*

Date of Birth*

Monthly Rent/Mortgage Amount*

Residence Type*

Beginning Date of Residency*

This is the date you started living at your current residence

Previous Address

Driver License Number*

Driver License State issued*

Driver License Expiration Date*

Employment info

Employer Name*

Employer Address*

Employer City*

Employer State*

Employer Zip Code*

Employer Phone #*

Occupation*

Gross Monthly Income*

Starting Date of Employment*

Additional Income

Co-Applicant Info

First Name

Last Name

Phone #

Street Address

Address Line 2

City

State

Zip Code

Residence Type

Date of Residency

Monthly Rent/Mortgage

Social Security

Date of Birth

Driver's License

Driver's License State

Co-Applicant Employment Info

Employer Name

Employer Phone #

Employer Address

Employer City

Employer State

Employer Zip

Occupation

Employment Status

Date of Employment

This is the date you started your employment

Gross Monthly Income

Additional Income Source

Any source outside of your full-time employment in which you receive a regular (dependable) income from

Additional Income (Monthly Amount)

The amount of money you make from your additional income source

Tell us about the vehicle you want

Year*

Make*

Model*

Vehicle Mileage*

Trim

Stock Number*

VIN Number*

Down Payment Amount*

Total Loan Amount*

Trade-In Vehicle Information

Trade In? (Yes/No)*

Yes

Trade-In VIN

Trade-In Year

Trade-In Make

Trade-In Model

Trade-In Mileage

Trade-In Payoff Amount

What Bank is the Trade-In Financed With?

Additional Comments

By submitting this application, I certify that all information herein is true and complete. I agree I am providing this information to the dealer identified in this application and acknowledge that my information may be shared pursuant to the dealer’s privacy policy, if applicable. I hereby authorize this dealer, and any financial institution engaged as a service provider by this dealer, to retain this application and to check and verify my credit, employment and salary history. By submitting this application, I acknowledge I am authorizing this dealer to check my credit.*

In connection with your transaction, CU AutoBranch 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 CU AutoBranch 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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