AutoWorld of Conway | Pre-Qualify for a preowned / used vehicle

AutoWorld of Conway: Pre-Qualify

Pre-Qualify for a used vehicle loan by filling out the form below.
This is not a credit application. This is a Customer Information Form. There are no wrong answers. Fill it out completely and either print it out and bring it in or click on the Submit button at the bottom.


Personal Information
First Name:
Middle Initial:
Last Name:
Address:
City:
State / Zip:	/
Previous Address:
Previous City:
Previous State / Zip:	/
Home Phone:	( ) -
Work Phone:	( ) - , ext.
Email
Social Sec. #:	- -
Date of Birth:	month day year

Residence Information
Residence Type:	Own Rent
How Long?	yrs. mos.
How Long at Prior Residence?	yrs. mos.

Employment Information
Employer:
Phone:	( ) -
Time with Current Employer:	yrs. mos.
Monthly Income (gross): $
Current Job Title:
Previous Employer:
Phone:	( ) -
Time with Previous Employer:	yrs. mos.
Monthly Income (gross):
Previous Job Title:

Down Payment Information
How much do you have towards a down payment?

Trade-In Information
Do you have a trade-in?	Yes No
Year of vehicle:
Make of vehicle:
Model of vehicle:

Other Information
Is this your first car purchase?	Yes No
How did you hear about us?

Information about vehicle you want to purchase
VIN:
Year of vehicle:
Make of vehicle:
Model of vehicle:
Miles on vehicle:
Vehicles options:
Amount Requested: $

I have read and fully understand the Privacy Disclaimer below.

CUSTOMER CHOICE

We have built our business on a foundation of integrity, honesty and trust. These values are reflected in our longstanding commitment to protect your privacy. In order to provide the kind of service that you deserve, we will from time to time have reason to share your personal nonpublic information with those affiliated and/or nonaffiliated third parties that we do business with. However, you may opt to prohibit this sharing of information, except as otherwise provided by or required by state or federal law or court order. If you wish to do so, check the appropriate box or boxes below and return this form to our offices. You do not need to take any action in order for us to continue to provide products and services to you.

AUTHORIZATION

Check this box to authorize us to share your nonpublic personal information with affiliated and/or nonaffiliated third parties. I understand that in checking this that you may be better able to serve me and that I may receive offers for other products and services that may be of value to me.

NONAFFILIATED

Check this box if you do not want us to Share your personal nonpublic information With nonaffiliated third parties except as permitted by law. (Note: If there are joint parties to your account, any party may Complete this form which will apply to all parties on the account. If you check this, you may not receive offers for other products and services that may be of value to you.)

AFFILIATED

Check this box if you do not want us to share your personal nonpublic information with affiliated third parties except as permitted by law. (Note: If there are joint parties to your account, any party may complete th~s form which will apply to all parties on the account. If you check this, you may not receive offers for other products and services that may be of value to you.)

(Note: This form is supplied as required by federal and/or state law, however, it is not necessary for you to take any action for our company to continue to serve your needs. Thank you, we appreciate your business.)