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Dealer Credit Application 1. Personal Information Applicant's Name   # Dependents   Social Security #   Date of Birth     (mm-dd-yyyy) 2. Current Address Street   Phone   City   Time at Present Address State   Zip   Years   Months   Own or Rent   Own Rent Mortgage Bank or Landlord       Year purchased     (if own) Purchase Price   Monthly Payment Balance       3. Prior Address Street   City     State   Zip     How Long?     4. Nearest Relative not in Household Name   Phone   Street   Relationship   City     State   Zip     5. Present Employer Company Name   Supervisor   Street   Phone   City   How Long Yrs   Mos   State   Zip   Salary   per   Week Bi-Weekly Semi-Monthly Month Year   Title       6. Prior Employer Company Name   Title     How Long Yrs   Mos         7. Creditors/Major Credit Cards/Major Department Stores   Name Addr or Acct Num Open/Closed Balance Mo Payment Date Closed 1. Open Closed 2. Open Closed 3. Open Closed 4. Open Closed 5. Open Closed               8. Previous automobile financed by   Open Closed 9. Bank Reference Name Address Type Checking Savings 10. Spouse - Complete this section ONLY if spouse will also be contractually liable for repayment of applicant is relying on the income of the spouse. Co-Applicants other than spouse must complete a separate application. Name   Date of Birth     (mm-dd-yyyy) SSN     Employer   Company Name   Supervisor   Street   Phone   City   How Long? Yrs   Mos   State   Zip   Salary   per   Week Bi-Weekly Semi-Monthly Month Year Name and address of nearest relative not in household Name   Phone   Street   Relationship   City     State   Zip     I (we) certify the above information to be true in every respect and that it correctly reflects my current financial condition. I (we) authorize the Creditor to make whatever credit inquiries it deems necessary in connection with this credit application or in the course of review or collection of any credit extended in reliance on the application including, without limitation, inquiries to any agency of government - federal, state, or local. I (we) authorize and instruct any person, governmental agency or consumer reporting agency to compile and furnish the Creditor any information it may have or obtain in response to such inquiries and agree that same shall remain the property of the Creditor whether or not credit is extended. Have any of the undersigned filed bankruptcy or have any judgements, repossessions, garnishments or other legal proceedings filed against the undersigned in the last seven years? Yes No   If yes, please explain:   Initials   Date   Initials   Date   PRIVACY POLICY The protection of your nonpublic personal information is important to our dealership. It is common for companies like ours to share your nonpublic personal information with affiliated third parties (a company that is related by common ownership or corporate control) and, in some cases, with nonaffiliated third parties. Because we recognize that keeping your nonpublic personal information private is important to you, we would like to take this opportunity to explain our Privacy Policy. About Our Privacy Policy Our Privacy Policy applies to those persons who obtain from us, financial products or services to be used for personal, family, or household purposes. Our goal is to respond to your inquiries and to provide products, services and other information you request. This Privacy Policy explains: • The types of information we may collect about you • The types of information we may disclose to third parties • The types of third parties to whom we may disclose information • How we protect the nonpublic personal information we collect about you The Types of Information We May Collect About You We may collect nonpublic personal information about you from the following sources: • Information we receive from you on applications or other forms, such as your name, address, telephone numbers, e-mail addresses, birth date, social security number, income, and employment history. • Information about your transactions with us or others, such as your account balances and payment histories. • Information we receive from your consumer credit reports or a consumer reporting agency, such as your credit worthiness, credit score or credit history. • Representations made by you to us, such as your employment history, account balances, payment histories, and your relationship with other persons or entities that you have listed as references. The Types of Information We May Disclose We may disclose all of the nonpublic personal information that we collect about you as a consumer, customer, or former customer to third parties as permitted by law. We may also disclose the nonpublic personal information we collect about you to third parties that perform services on our behalf or in connection with the products and services we sell or to other financial institutions with whom we have joint marketing agreements, such as third parties who: manufacture, supply, or administer the goods and services, including insurance products, warranties and extended service contracts; advertise or market the products and services; make service and customer satisfaction inquiries on our behalf; or provide other related marketing services. We are permitted by law to disclose information about you to third parties that perform such services and/or to other financial institutions with whom we have joint marketing agreements. We are not required to give you the opportunity to opt out of such disclosures. How We Protect The Nonpublic Personal Information We Collect About You We take our responsibility to protect your nonpublic personal information very seriously. Whenever we collect information about you, we restrict access to you nonpublic personal information to our employees and those third parties who need the information to respond to your inquiries, to provide better customer service, and to provide products, services and other information you request. We explain the importance of protecting your nonpublic personal information to our employees and take appropriate measures to enforce employee responsibilities regarding our Privacy Policy. We also maintain physical, electronic and procedural safeguards to protect the confidentiality and security of the information we collect. We require any third party who receives information about you from us to agree to keep that information confidential and to use the information only as permitted by law. We appreciate your business and the opportunity to assist you in understanding our Privacy Policy. We hope that you have found this information to be useful and appreciate the opportunity to continue to serve you in the future. If you have any questions about our privacy policies, please feel free to contact us.   I have read and understand the Free Bridge Auto Sales Privacy Policy displayed above.

Free Bridge Auto Sales 1400 Richmond Road Charlottesville, VA 22911
Sales 434-296-0006 Service 434-979-2886