Secure Client Information & Dealership Submission
Complete this secure form so Black Key Auto Group can prepare your information for the dealership handling your vehicle transaction. Black Key Auto Group does not run credit or make lending decisions. The dealership you approve will process the formal credit application.
1. PERSONAL INFORMATION
First Name
*
Middle Name (Optional)
Last Name
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Social Security Number
*
Email Address
*
Phone Number
*
Format: (000) 000-0000.
2. DRIVER’S LICENSE
Driver’s License Number
*
Issuing State
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Expiration Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Upload Front of Driver’s License
*
Browse Files
Drag and drop files here
Choose a file
Upload a clear image or PDF of the front of your current driver’s license.
Cancel
of
Upload Back of Driver’s License
*
Browse Files
Drag and drop files here
Choose a file
Upload a clear image or PDF of the back of your current driver’s license.
Cancel
of
3. CURRENT RESIDENCE
Street Address
*
Apt/Suite/Unit
City
*
State
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP Code
*
Time at Address
*
Please Select
Less than 1 year
1–2 years
2–3 years
3–5 years
More than 5 years
Housing Status
*
Please Select
Own
Rent
Live with Family
Other
Monthly Rent/Mortgage
*
4. EMPLOYMENT INFORMATION
Employer Name
*
Job Title
Employer Phone
*
Format: (000) 000-0000.
Time on Job
*
Please Select
Less than 1 year
1–2 years
2–3 years
3–5 years
More than 5 years
Gross Monthly Income
*
5. INSURANCE
Upload Current Insurance Card
*
Browse Files
Drag and drop files here
Choose a file
Upload a clear image or PDF of the current insurance identification card. The dealership may request updated proof of insurance before delivery.
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of
6. AUTHORIZATION
Authorization to Collect Information
*
I authorize Black Key Auto Group to collect and securely maintain the information provided in this form for the purpose of preparing and coordinating my vehicle transaction.
Authorization to Share Information
*
After I approve the selected dealership, I authorize Black Key Auto Group to securely send my information and uploaded documents to that dealership for processing.
Credit Processing Acknowledgment
*
I understand that Black Key Auto Group does not pull my credit, approve financing, or make lending decisions. The dealership I approve will handle the formal credit application and any lending decision.
7. SIGNATURE
Applicant Signature
*
Printed Legal Name
*
Date Signed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
SUBMIT SECURE CLIENT INFORMATION
Should be Empty: