Secure Finance Application
Secure Form
Personal Information
Full Name*:
SS or Tax ID #*:
Date of Birth*:
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E-mail*:
(ex. johndoe@anywhere.com)
Phone*:
(ex. 505-555-5005)
Address *:
City*:
State / Zip *:
/
(ex. NY / 10005)
Employment Information
Business Phone:
Housing Information
Time at Current Residence:
Additional Comments
Please include any information that you feel may help us process your application.
Important Privacy Information
In connection with your transaction, Suburban Automotive Associates dba Suburban Mitsubishi may obtain information about you as described in this notice, which we handle as stated in this 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: a) Information we receive from you on applications or other forms in connection with a financial transaction: b) Information about your transaction s with us, our affiliates, or others: and c) Information we receive from a consumer reporting agency. 2] We may disclose all of the information we collect, as described above, to companies that perform marketing services or other functions on our behalf or to other financial institutions with which we have joint marketing agreements. We may make such disclosures about you as a consumer, customer or former customer. 3] We may also disclose non-public personal information about you as a consumer, customer, or former customer, to non-affiliated third parties as permitted by law. 4] 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.
I acknowledge that I have read the above notice.
Home Sales Service & Parts Finance Why Mitsubishi Contact Us
Suburban Mitsubishi | 6 Hartford Turnpike/Route 83, Vernon, CT 06066 E-Mail: mitsubishi@krausecars.com
