Contact Info

First Name*

Last Name*

Email Address*

Phone #*

Social Security #*

Date of Birth*

Residential Info

Street Address*

City*

State*

Zip Code*

Rent or Own?

Time at Present Address*

Monthly Payment/Rent*

Previous Residential Info (If at current address less than 2 years)

Previous Street Address

Previous City

Previous State

Previous Zip Code

Previous Monthly Payment/Rent

Employment Info

Company or Employer Name*

Employer Phone*

Time at Present Job*

Occupation or Job Title*

Self Employed, W2?

Monthly Income before Taxes*

Additional Monthly Income before Taxes

Additional Income Source

Previous Company Name (if current is less than 2 years)

Time at Previous Job (if current is less than 2 years)

Co-Applicant Contact Info

First Name*

Last Name*

Phone #*

Social Security*

Date of Birth*

Co-Application Residential Info

Street Address*

Address Line 2

City*

State*

Zip Code*

Rent or Own?

How Long?*

Monthly Payment/Rent*

Previous Residential Info (If at current address less than 2 years)

Previous Street Address

Prevous Address Line 2

Previous City

Previous State

Previous Zip Code

Previous Monthly Payment/Rent

Co-Applicant Employment & Income Info

Company or Employer Name

Employer Phone

How Many Years?*

Occupation or Job Title*

Self Employed, W2?

Monthly Income Before Taxes*

Additional Monthly Income Before Taxes

Additional Income Source

Previous Company Name (if current is less than 2 years)

Time at Previous Job (if current is less than 2 years)

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Model

Trim

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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, Wissler Motors 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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