BUSINESS CREDIT INFORMATION

Legal Business Name*

Tax ID *

Business Phone *

Street Address*

City*

State*

Zip Code*

Bank Name*

Checking Account Number*

Contact Name at Bank*

Contact Phone Number*

Email Address*

Certificate of beneficial owner(s)

First Name*

Last Name*

Country(ies) of Citizenship*

% of Ownership*

Date of Birth*

Social Security #*

Driver's License*

Issuance Date*

Expiration Date*

Address*

City*

State*

Zip Code*

Tell us about the vehicle you want

Year

Make

Model

Trim

Trade In?

yes

Trade-In Year

Trade-In Make

Trade-In Model

Trade-In Mileage

Payoff

DIGITIAL SIGNATURE.

Signature*

Title*

Date*

HOW WOULD YOU LIKE US TO CONTACT YOU?

Call

Text

I agree to give permission for the above applicant(s) Consumer Credit Report(s) to be obtained, at no cost to me, in order to help determine the types and extent of financing which are available**

In connection with your transaction, Carolina Auto Direct 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 Dealerfire 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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