Bert's Mega Mall : SPECIAL FINANCING

THIS IS OUR SPECIAL FINANCE APPLICATION.
Get Started, or Re-Establish Your Credit Today!
Your information will be directed to our SPECIAL FINANCING department.
WE CAN FINANCE ANYONE!

Your contact information: (*) - required fields.

PERSONAL INFORMATION
*Name (first, last):
*Social Security Number:
*Date of Birth:
*Driver's License Number:
*Address:
*City:
*State:
*Zip:
Phone:
How many years at this address:
Previous Address:
How many years at this address:
EMPLOYMENT and INCOME:
Employer:
Occupation/Title:
Employer Address:
Employer Phone:
How many years:
Current Monthly Salary/Wage:
Previous Employer:
How many years:
Previous Employer Address:
Other monthly income:
Name of Bank:
Click all that apply:	Checking Savings
Monthly Mortage/Rent:
ADDITIONAL INFORMATION: Please take a few moments to answer the following questions so that we may better assess your finance needs.
How much down payment do you have right now?
What is the maximum payment you can make?
Are you currently employed?	Yes No
How Are You Paid?	Company Check Cash
Can you acquire full coverage insurance?	Yes No
Do You Have A Cell Phone Number You'd Prefer We Call?
Do You Have A Fax Number Where We Can Fax You An Application?
The following documents will be required to complete your loan request: Complete Phone Bill (2) Most Recent Pay Stubs - showing year to date income Utility Bill (7) Verifiable References - Name, Address and Phone Number Landlord Information Full Coverage Insurance with no more than $500 deductible Legitimate Photo Identification, (Driver's License or State I.D.)
OTHER:
Is there anything you would like to tell us about your financial history?:
What are you interested in purchasing?:
*Email Address:
How should we contact you?:
Privacy Policy \| Electronic Disclosure \| Federal Notices
By clicking 'Accept / Submit', below, you submit and certify that all of the statements in this application are true and made for the purpose of obtaining credit. You authorize us to begin a credit investigation, including obtaining your consumer credit report, and to forward or allow direct electronic access, your application to lenders, financial institutions, or other third parties in order to process your application. We the Dealer, may obtain information about you as described in this notice, which we handle as stated in this privacy policy notice. This does not apply to information obtained in a non-financial transaction. 1. We collect nonpublic personal information about you from the following sources:· Information we receive from you on applications or other forms in connection with a financial transaction;· Information about your transactions with us, our affiliates, or others; and· Information we receive from a consumer reporting agency. 2. We do not sell customer or consumer information to any third party. We may disclose the information we collect, as described above, to our affiliates, to other financial institutions with whom we have joint marketing agreements, or to companies that perform services or functions on our behalf. These companies may include financial service providers and non-financial companies such as computer and data processing companies, and marketing and aftermarket service providers. These companies will be contractually obligated to keep the information we provide them confidential and to use the information only to provide the services requested of them. We observe limits and restrictions set by law as to sharing of information with our affiliates or others.3. 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.