Application Information     * Required Fields
*Choose Location   Nearest You:	Make Selection Motormax Motormax of Auburn Motormax of Augusta Motormax of Birmingham-N Motormax of Birmingham-S Motormax of Columbus Motormax of Montgomery Motormax of Phenix City Motormaz of LaGrange
*First name:
Middle name:
*Last name:
Date of Birth:	January February March April May June July August September October November December
Social Security No.:	-  -
Email:
*Day Phone:	(  )  -
Evening Phone:	(  )  -
Address:
*City:
*State:
Zip:
How Long at Address:	Years:  Months:

Employment Information
*Employer:
Address:
*City:
*State:
Zip:
Occupation:
How long:	Years:  Months:
*Monthly Income:
Previous Employer:
Address:
Years:
Previous Employer:
Address
Years:

Contact Information
Reserve a date and time that you can come in to talk about your new vehicle.	Best time to call:	1 2 3 4 5 6 7 8 9 10 11 12 :  00 15 30 45   AM PM
	Appointment Desired:
	Set Appointment:
	Appointment Time:	1 2 3 4 5 6 7 8 9 10 11 12  :  00 15 30 45 AM PM

* You certify that all the representations contained in this application are truthful and correct and you hereby authorize MOTORMAX and/or the Financial Institutions with whom it deals, to gather whatever credit and employment history they consider necessary and appropriate, including your consumer credit report. You also authorize MOTORMAX Automotive Group to provide credit information concerning this transaction, including, if applicable, a consumer credit report, to the Financial Institutions. You understand that MOTORMAX and/or any Financial Institution with whom it shares your information will retain this information whether or not your application is approved. You agree that you will notify MOTORMAX and any applicable financing institution of any changes of name, address or employment prior to consummating your purchase or lease of a motor vehicle from MOTORMAX . You understand that you may be required to provide verification of representations made in this application and as such you may be required to provide additional documentation which includes, but is not limited to, W-2s, income tax returns, utility bills, financial statements and pay check stubs. You agree to provide, upon request such additional documentation as may be necessary to process this credit application. You agree and understand that this information may be submitted to Financial Institutions in order to obtain a credit approval.

Notice of Privacy

• As Part of our finance business, we obtain certain "nonpublic personal financial information" about you. Which for ease of reading we will refer to as "Information" in this notice. This Information includes Information we received from you on your application or other forms, Information about your transactions with us, our affiliates or others, and Information we receive from consumer reporting agency.
• We restrict access to the Information to authorized individuals who need to know this Information to provide service and products to you.
• We maintain physical, electronic, and procedural safeguards that protect your information.
• We do not disclose this Information about you or any former customer to anyone except as permitted by law.
• Employees share this Information outside the company only as authorized by you or for a specific business purpose.
• The law also permits us to share this Information with companies that perform marketing services for us, or other financial institutions that may service or purchase your retail installment sales contact.

We may also share other types of information with our affliates including finance companies or automobile companies. This Infomation may be financial or other personal Information such as employment history and it may be directly related to our transaction with you. Consistent with the Fair Credit Reporting Act, our standard authorizations permit us to share this Information with our affliates.