Portland Auto Wholesalers Direct | Portland Dealerships

This form is secure for your safety and is NOT sent via email.
To apply for financing, fill in the form and click submit - Thank You!

VEHICLE INFORMATION
Make:
Model:
Year:
Price of Vehicle:
Down Payment:
Lease Purchase Undecided
Do you have a trade-in?:	Yes No
Make of Trade-in:
Year of Trade-in:
Payoff Amount:
Condition of Trade-in:

Primary Applicant's Personal Credit Information

First Name:
Last Name:
Middle Initial:
Social Security Number:
Date of Birth:
E-mail Address:
Home Phone:
Cell Phone:
Address:
City/State:
Zip:
Mortgage or Rent Payment:
Time at Current Residence(Years, Months):
Less than 2 Years at current address:	Yes No
Previous Address: (If less than 2 years at current address)
City/State: (If less than 2 years at current address)
Zip: (If less than 2 years at current address)
Current Employment
Current Employer Name:
Current Employer Phone:
Current Employer Address:
Current Employer City/State:
Current Employer Zip:
Position:
Annual Gross Income:
Time on Job (Years, Months):
Less than 2 Years with current employer:	Yes No
Previous Employer Name(If less than 2 years with current employer):
Previous Employer Phone:
Previous Employer Address:
Previous Employer City/State:
Previous Employer Zip:
Position:
Annual Gross Income:
Time on Job (Years, Months):
Co-Applicant is Required:	Yes No

Please read the below privacy notice, and select Accept to continue or Decline to cancel.

Privacy Notice

In connection with your transaction, the dealership may obtain
information about you as described 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 or others; and, 
  
	Information we receive from consumer reporting agency (e.g., credit bureau).

2. We may disclose all of the information we collect, as described above,
to companies that perform marketing services on our behalf or to 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 customer, customer for former customer to non-affiliated third parties
as permitted by law.

4. We restrict access to nonpublic personal information about you to
those dealership personnel who need to know that information in order to
determine your eligibility for products and services, and to provide you
with products and services, and to those who are subject to confidentiality
provisions and restrictions that prohibit use of information beyond the
performance of specified services. To guard your nonpublic personal
information we maintain physical, electronic, and procedural safeguards
that comply with federal standards.

Accept, I have read the privacy notice above and give you authorization to check my credit
Decline, I do not give you authorization to check my credit

Review the information you have provided. If all of the information is accurate, press the submit button.