Full Name

Email Address

Phone #

Date of Birth

Address

Apt/Unit

How long have you been at this residence

Social Security #

Driver's License #

I have read the

I have a Co-Applicant

Requested Sales Rep

By clicking “Accept/Submit”, you submit and certify that a) you acknowledge receipt of the dealership Privacy Policy and Electronic Disclosure as accessed by the Privacy Policy and Electronic Disclosure links on the first page of this application, b) 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 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 non-public 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. Unless otherwise stated in our privacy policy, we do not sell customer or consumer information to any third party. Unless otherwise stated in our privacy policy, 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 non-public 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 non-public personal information.

Desired Vehicle

New or Used New Used

Make

Model

Income

Monthly Rent / Mortgage

Gross Monthly Income

Other Income / Alimony

Current Employer

Employer

Position

Phone #

How long have you been working for this employer?

Previous Residence

Address

Apt/Unit

How long have you been at this residence

Previous Employer

Employer

Position

Phone #

How long did you work for this employer?

Co-Applicant Info

Full Name

Email Address

Phone #

Date of Birth

Co-Applicant Info

Address

Apt/Unit

How long have you been at this residence

Social Security #

Driver's License #

Co-Applicant Income

Monthly Rent / Mortgage

Gross Monthly Income

Other Income / Alimony

Co-Applicant
Current Employer

Employer

Position

Phone #

How long have you been working for this employer?

Co-Applicant
Previous Residence

Address

Apt/Unit

How long have you been at this residence

Co-Applicant
Previous Employer

Employer

Position

Phone #

How long did you work for this employer?

Thank You

Your credit application has been received!

One of our finance Professionals will review your application shortly. They will call you to confirm Information you Provided, as a courtesy and also to Protect your privacy and identity in the event this information was not submitted by you.

If you no longer wish to have the credit application processed, you will need to contact our dealership directly. You may also request a printed copy of the information you submitted within 7 days of the date you submitted your application.

Privacy Policy

Facts

WHAT DOES Honda Of Melbourne DO WITH YOUR PERSONAL INFORMATION?

Why?

Financial companies choose how they share your personal information. Federal law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do.

What?

The types of personal information we collect and share depend on the product or service you have with us. This information can include:

Social Security number and income
employment information and payment history
credit history and credit scores

How?

All financial companies need to share customers' personal information to run their everyday business. In the section below, we list the reasons financial companies can share their customers' personal information; the reasons Honda Of Melbourne chooses to share; and whether you can limit this sharing.

Reasons we can share your personal information

Does Honda Of Melbourne share?

Can you limit this sharing?

For our everyday business purposes-- such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus

Yes

For our marketing purposes-- to offer our products and services to you

Yes

For joint marketing with other financial companies

Yes

For our affiliates' everyday business purposes-- information about your transactions and experiences

For our affiliates' everyday business purposes-- information about your creditworthiness

For our affiliates to market to you

For nonaffiliates to market to you

Questions

Go to 855-453-2011

Mail-in Form

Leave Blank OR [If you have a joint account, your choice(s) will apply to everyone on your account unless you mark below.

Apply my choices only to me.]

Mark either/both you want to limit:

Do not allow your affiliates to use my personal information to market to me.

Do not share my personal information with nonaffiliates to market their products and services to me.

Name
 
Mail To:

Address
 
Honda Of Melbourne

City, State, Zip
 
790 South Apollo Blvd 

VIN # (last 8 digits)
 
Melbourne, FL 32901

What we Do

How does Honda Of Melbourne protect my personal information?

To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings.

How does Honda Of Melbourne collect my personal information?

We collect your personal information, for example, when you

apply for a lease or apply for financing
show your driver's license or give us your income information
provide employment information

We also collect your personal information from others, such as credit bureaus, affiliates, or other companies.

Why can't I limit all sharing?

Federal law gives you the right to limit only

sharing for affiliates' everyday business purposes -- information about your creditworthiness
affiliates from using your information to market to you
sharing for nonaffiliates to market to you

State laws and individual companies may give you additional rights to limit sharing.

Definitions

Affiliates

Companies related by common ownership or control. They can be financial and nonfinancial companies.

Our affiliates include other automobile dealerships within our dealership group, our management company, and a related company which promotes, markets and sponsors motorsports.

Nonaffiliates

Companies not related by common ownership or control. They can be financial and nonfinancial companies.

Honda Of Melbourne does not share with nonaffiliates so they can market to you.

Joint marketing

A formal agreement between nonaffiliated financial companies that together market financial products or services to you.

Our joint marketing partners include automobile manufacturers, providers and/or administrators of aftermarket products, financial institutions, insurance companies or agencies, and companies that provide marketing services.

Addendum

Consent for Electronic Disclosures Electronic Signatures in Global and National Commerce Act

Introduction: You are submitting a request for a loan pre-qualification, a loan application or form through us (hereinafter, a "Request"). We can only give you the benefits of our service by conducting our business through the Internet. In order to do this, we need you to consent to our giving you certain disclosures electronically. This document informs you of your rights when receiving legally required disclosures, privacy notices and information ("Disclosures") from us and the lenders to whom your Request is submitted. By completing and submitting a Request through us, you acknowledge receipt of this document and consent to the electronic delivery of such Disclosures.

Electronic Communications: Any Disclosures related to your Request will be provided to you electronically through our technology provider, Laser Stream Video. However, if you wish to obtain a paper copy of any of the Disclosures, you may contact our dealership directly with the details of your request.

Consenting to Do Business Electronically: Before you decide to do business electronically with us, you should consider whether you have the required hardware and software capabilities described in this document.

Scope of Consent: Your consent to receive Disclosures and to do business electronically, and our agreement to do so, only applies to this Request. Information you provide in this request is deposited in a secure database with Laser Stream Video, and is provided only to our specified dealership personnel and/or our Contact Relationship Management software provider. Laser Stream Video does not share your information with any third party other than this dealership, our affiliates and lenders as necessary to maintain contact with you and process your request for vehicle loan approval. You may receive Disclosures from our technology provider Laser Stream Video, and you may also receive Disclosures and other communications from our participating Lenders. After your Request is transmitted to one or more of our participating Lenders, and after you decide to continue to pursue your Request, then you and the Lender should discuss how subsequent Disclosures will be delivered.

Hardware and Software Requirements: To access and retain the Disclosures electronically, you will need to use the following computer software and hardware: Internet Explorer 4.0 or above, Netscape Navigator 4.0 or above or equivalent software; and hardware capable of running this software.

Withdrawing Consent: Because we will provide the Disclosures to you instantaneously, you will not be able to withdraw your consent to do business electronically with us. However, you may withdraw your consent to do business electronically with our participating Lenders at no cost to you. You may do so by contacting the Lender at the mailing address, e-mail address or telephone number they provide with their offer. If you decide to withdraw your consent, the legal validity and enforceability of prior electronic Disclosures will not be affected.

Changes to Your Contact Information: You should keep us informed of any change in your electronic or mailing address. You may update your information by sending a fax to 678-623-8803 regarding any such changes.

YOUR ABILITY TO ACCESS DISCLOSURES. BY COMPLETING AND SUBMITTING YOUR REQUEST, YOU ACKNOWLEDGE THAT YOU CAN ACCESS THE ELECTRONIC DISCLOSURES IN THE DESIGNATED FORMATS DESCRIBED ABOVE.

cxc

Federal Notices

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT: To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

STATE NOTICES: Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington or Wisconsin Residents: If you, the applicant, are married and live in a community property state, you should also provide the personal credit information on your spouse in the co-applicant section. Your spouse is not required to be a co-applicant for the credit requested unless he/she wishes to be a co-applicant. California Residents: An applicant, if mcentric arried, may apply for a separate account. Ohio Residents: Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law. New Hampshire Residents: If this is an application for balloon financing, you are entitled to receive, upon request, a written estimate of the monthly payment amount that would be required to refinance the balloon payment at the time such payment is due based on the creditor's current refinancing programs. New York Residents: In connection with your application for credit, we may request a consumer report that contains information on your credit worthiness, credit standing, personal characteristics and general reputation. If we grant you credit, we or our servicer may order additional consumer reports in connection with any update, renewal or extension of the credit. If you ask us, we will tell you whether we obtained a consumer report and if we did, we will tell you the name and address of the consumer reporting agency that gave us the report. Vermont Residents: By clicking on "Submit", you authorize us and our employees or agents to obtain and verify information about you (including one or more credit reports, information about your employment and banking and credit relationships) that we may deem necessary or appropriate in evaluating your application. If your application is approved and credit is extended, you also authorize us, and our employees and agents, to obtain additional credit reports and other information about you in connection with reviewing the account, increasing the available credit on the account (if applicable), taking collection on the account, or for any other legitimate purpose. Married Wisconsin Residents: Wisconsin law provides that no provision of any marital property agreement, or unilateral statement, or court order applied to marital property will adversely affect a creditor?s interests unless, prior to the time that the credit is granted, the creditor is furnished with a copy of the agreement, statement or decree, or has actual knowledge of the adverse provision. If you are making this application individually, and not jointly with your spouse, the full name and current address of your spouse must be properly disclosed in the co-applicant section of this application.