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	*Auto Brokers of Montgomery* is now offering an on-line application approval to help make your experience of buying a new or used car from us convenient and rewarding. In order for us to better serve you please be sure to fill out the form below completely. You can also print and fax this form to 334-281-0325.


	Personal Information

Last Name	First Name	MI

Social Security #	Date of Birth	Name on utility bill	How long	at address
			Yrs	Mos

Address # Street Apt #	Home Phone #	Additional Phone #

City	State	Zip Code	Email Address

Own or Rent?	Monthly Pmt	Landlord Name	Landlord Phone #

Previous Address # Street Apt #	City	State	How long at prev?

Mailing Address (if different from above)


	Employment

Employer Name	Occupation	Military Rank (if appl)	How long at Job?

Employer Address # Street Name	Phone #	Extension

City	State	Zip Code	Supervisor	Monthly	Income
				Gross	Net

Previous Employer	Prev Employer Address	Other Income *	Amount *


	* Alimony or chld support need not be revealed if not using it as a basis of repaying obligation


	Other Information

Vehicle you are interested in?	Do you have a trade?	Make/Year/Model

Do you owe money on your trade in?	If so, how much do you owe?

By submitting this application, I agree to the following:

I am at least 19 years of age.
I may submit my application to Auto Brokers of Montgomery electronically by clicking "Submit Application" below. I acknowledge that, regardless of whether I use a web browser with security features, Auto Brokers of Montgomery is unable to ensure that the data will not be intercepted by third parties. Auto Brokers of Montgomery will not be held liable should such interception occur.
I certify that the above information is complete and accurate. In connection with this application, I authorize and give Auto Brokers of Montgomery and any of its affiliates or subsidiaries my consent to obtain my credit report from any Credit Reporting Agency and complete an investigation of my credit and employment history and release information about my credit experience with you.

Privacy Policy
In connection with your transaction, Auto Brokers of Montgomery, may obtain information about you as described in this notice, which we handle as stated 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 transaction with us, our affiliates or others;
Information we receive from a consumer reporting agency.

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

4. We restrict access to nonpublic personal information about you to those employees who need to know that information to provide products or services to you. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information

Click the circle to the right to agree to the terms above and to run a credit report on you.

** Please Note: If the application is successful you will be taken to the Home Page of our website. **