Credit Application Form

Form
Unit Details

Unit ModelUnit PriceColor
Principal Name

First NameMiddle NameLast Name
Age
Sex
Tin no.
Please provide your Tin no.
Birthday
MM/DD/YY
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Length of stay
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employee/Business Information
Employer/Business Name
Employer/Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer/Business Contact number
Please enter a valid phone number.Format: (000) 000-0000.
Job Tilte/Position
Length of stay
Monthly Income
Spouse/Co-Maker
Name

First NameMiddle NameLast Name
Age
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birthday
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer/Business Information
Employer/Business Name
Employer/Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employer/Business Contact no.
Please enter a valid phone number.Format: (000) 000-0000.
Job Title/Position
Length of stay
Monthly Income
Bank
Bank Type
Bank Name
Branch
DATA PRIVACY ACT WAIVER TO BE INCLUDED IN AND CONSIDERED PART AND PARCEL OF THE CREDIT APPLICATION FORM AND DOCUMENTS: Hereby authorize MITSUBISHI SHAW - STRASBOURG AUTO GROUP to process and share my personal data to any ccredited banks, which is likewise authorized to received, use, collect and process my personal for the purpose of financing my purchase of auto vehicle/s from the dealer assignment of the 's rights to its accredited banks, including verification, customer, profilling, cross checking and nvestigation. In this regards, my personal information may also be shared with accredited bank nes, subsidiaries, affiliates, representative or third party service provider. I am also aware that details of how my personal data will be processed and the rights are listed in the accredited nks Privacy Policy Statement which i may secure from the accredited banks(s) concerned
Principal Signature
Should be Empty:

Form

Employee/Business Information

Spouse/Co-Maker

Employer/Business Information

Bank