Online Credit Application
Page 1  
Applicant
  Fields marked with * are required.  
First Name: * Date of Birth: *
M.I.: * S.S.# * - -
Last Name: *
Phone 1: *
Phone 2: *
Email:
 
How would you like us to contact you:
 *
Current Address
Street: *
City: *
State: *
Zip: *
Residence:
  Type: *
  Years There: *
  Months There: *
  Payment: *
Previous Address(If Less Than 2 Years)
Street: *
City: *
State: *
Zip: *
Residence:
  Type: *
  Years There: *
  Months There: *
  Payment: *
Current Employer
Name: *
Phone: *
Years There: *
Months There: *
Position Held: *
Gross Monthly: *
Previous Employer (If Less Than 2 Years)
Name: *
Phone: *
Years There: *
Months There: *
Position Held: *
Gross Monthly: *
Additional Monthly Income:
Nature of Income:
How long will it last: Years: Months:

Alimony, child support, separate maintenance payments, medical insurance payments, disability income, or wage continuation payments need not be revealed if Applicant does not choose to have it considered as a basis for repayment of this obligation.

Will you put money down? No   Yes    If Yes, how much?
 Additional Information that may help
 during our review process
Vehicle Interested In:
Trade-In Information: Year: Make: Model: Miles:
 Marital Status: *Single: Do Not Have A Co-applicant
*Single: Have A Co-applicant
*Married
*Legally Separated
NOTE: If 'Married' or 'Legally Separated', Spousal information is required
 
 
Online Credit Application
Page 2  
Spouse/Co-Applicant
  Fields marked with * are required.
 First Name: *  Date of Birth: *
 M.I.:      S.S.# * - * - *
 Last Name: *  
 Phone 1:
 Phone 2:
 Email:
 
 How would you like us to contact you:
 
Current Address
Street: *
City: *
State: *
Zip: *
Residence:
  Type: *
  Years There: *
  Months There: *
  Payment: *
Previous Address(If Less Than 2 Years)
Street: *
City: *
State: *
Zip: *
Residence:
  Type: *
  Years There: *
  Months There: *
  Payment: *
Current Employer
Name: *
Phone: *
Years There: *
Months There: *
Position Held: *
Gross Monthly: *
Previous Employer (If Less Than 2 Years)
Name: *
Phone: *
Years There: *
Months There: *
Position Held: *
Gross Monthly: *
Additional Monthly Income:
Nature of Income:
How long will it last: Years: Months:

Alimony, child support, separate maintenance payments, medical insurance payments, disability income, or wage continuation payments need not be revealed if Co-Applicant/Spouse does not choose to have it considered as a basis for repayment of this obligation.

 Additional Information that may help
 during our review process
 
 
Online Credit Application
Page 2  

Privacy Policy
Village Auto takes online privacy very seriously. This application is being created and transmitted in a secure environment. Your personal data will be encrypted. In connection with your transaction we may obtain nonpublic personal information about you and that information is handled as stated in this notice. This does not apply to information obtained in a non-financial transaction.

 1.

We collect personal nonpublic information about you from the following sources:

 
  a.

Information we receive from you on an application for credit or other similar forms;

 
  b.

Information about your transactions with us and others; and,

 
  c.

Information we receive from a consumer-reporting agency.

 
 2.

Please be aware that it is our policy to disclose the above nonpublic personal information to only those companies that perform marketing services or other functions on our behalf or to other financial institutions with which we have joint marketing agreements.

 
 3.

We do not disclose any nonpublic personal information about your to anyone except as permitted by law.

 
 4.

Further, we restrict access to your nonpublic personal information to only those employees who need to know that information to provide products or services to you. Employees cannot use your information for any other purpose. For your safety, we maintain physical, electronic and procedural safeguards that comply with federal regulations to further guard your nonpublic personal information.