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SUBMIT AN APPLICATION

Please select the type of Application you would like to submit: Personal Business

Select type of Personal Application: Individual Application Joint Application (co-signer)

APPLICANT - PERSONAL INFORMATION (PRINCIPAL DRIVER OF VEHICLE)

First Name: *

Middle Name:

Last Name: *

Date of Birth: *

Street Address: *

State: *

How Long? *

Years Months

Own or Rent? *

Own/Buying Rent/Lease

Live With Relative Other

Home Phone: *

If you have lived at your current address for less than 3 years, please enter your previous address into the fields below.

Previous Address: *

State: *

City: *

Zip: *

APPLICANT - EMPLOYMENT

Employer Name: *

How Long? *

Years Months

Gross Annual Salary: *

Employer Address: *

State: *

Position/Title: *

Work Phone: *

Other Income Source:

Annual Amount:

City: *

Zip: *

If you have been at your current employer for less than 3 years, please enter your previous employer into the fields below.

Previous Employer or School: *

How Long? *

Years Months

CO-APPLICANT - PERSONAL INFORMATION

First Name: *

Middle Name:

Last Name: *

Date of Birth: *

Street Address: *

State: *

How Long? *

Years Months

Own or Rent? *

Own/Buying Rent/Lease

Live With Relative Other

Home Phone: *

If you have lived at your current address for less than 3 years, please enter your previous address into the fields below.

Previous Address: *

State: *

City: *

Zip: *

CO-APPLICANT - EMPLOYMENT

Employer Name: *

How Long? *

Years Months

Gross Annual Salary: *

Employer Address: *

State: *

Position/Title: *

Work Phone: *

Other Income Source:

Annual Amount:

City: *

Zip: *

If you have been at your current employer for less than 3 years, please enter your previous employer into the fields below.

Previous Employer or School: *

How Long? *

Years Months

CONFIRMATION

E-mail Address: *

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Best Contact Number: *

Notes/Comments:

IIN CONNECTION WITH YOUR TRANSACTION OMG LEASING AND ALL ITS AFFILIATES MAY OBTAIN INFORMATION ABOUT YOU AS DESCRIBED IN THIS NOTICE.

1. WE COLLECT NONPUBLIC PERSONAL INFORMATION ABOUT YOU FROM THE FOLLOWING SOURCES:

* INFORMATION WE RECEIVED FROM YOU ON APPLICATIONS OR OTHER FORMS

* INFORMATION ABOUT YOUR TRANSACTIONS WITH US, OUR AFFILIATES OR OTHERS, AND

* INFORMATION WE RECEIVE FROM A CONSUMER AGENCY

2. WE MAY DISCLOSE ALL OF THE INFORMATION WE COLLECT AS DESCRIBED ABOVE TO COMPANIES THAT PERFORM MARKETING SERVICES ON OUR BEHALF OR TO OTHER FINANCIAL INSTITUTIONS WITH WHOM WE HAVE JOINT MARKETING AGREEMENTS.  WE MAKE SUCH DISCLOSURES ABOUT YOU AS A CONSUMER, CUSTOMER, OR FORMER CUSTOMER.

3. WE MAY ALSO DISCLOSE NONPUBLIC PERSONAL INFORMATION ABOUT YOU AS CONSUMER, CUSTOMER, OR FORMER CUSTOMER TO NON-AFFILIATED THIRD PARTIES AS PERMITTED BY LAW.

4. WE RESTRICT ACCESS TO NONPUBLIC 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 OR GUARD YOUR NONPUBLIC PERSONAL INFORMATION.

I, THE UNDERSIGNED, HEREBY AUTHORIZE OMG LEASING AND ITS AFFILIATES (COLLECTIVELY "PROSPECTIVE CREDITORS") TO VERIFY CREDIT AND EMPLOYMENT HISTORY AS STATED ABOVE AND TO ANSWER QUESTIONS ABOUT CREDIT EXPERIENCE WITH ME.  IF THIS APPLICATION IS MADE PURSUANT TO ANY CREDIT PROGRAM FOR ATTENDEES AND/OR GRADUATES OF SCHOOLS OR EDUCATIONAL OR EDUCATIONAL INSTITUTION(S), THEN PROSPECTIVE CREDITORS MAY VERIFY MY ELIGIBILITY FOR SUCH PROGRAM, INCLUDING BY INQUIRY TO MY SCHOOL(S) OR EDUCATIONAL INSTITUTION(S).  INSURANCE RELATED TO THE CREDIT FOR WHICH I AM APPLYING MAY BE PURCHASED FROM AN INSURER OR AGENT OF MY CHOICE WHO MEETS PROSPECTIVE CREDITOR STANDARDS.  IN CONNECTION WITH THIS APPLICATION FOR CREDIT, PROSPECTIVE CREDITORS MAY REQUEST A CONSUMER (CREDIT) REPORT.

I AUTHORIZE PROSPECTIVE CREDITORS TO ASK MY PAST AND CURRENT CREDITORS ("CREDIT REFERENCES"), INCLUDING CREDITORS LISTED ABOVE OR ON MY CONSUMER (CREDIT) REPORT, ABOUT MY CREDIT PERFORMANCE WITH THEM.  PROVISION BY PROSPECTIVE CREDITORS OF A COPY OF THIS AUTHORIZATION SHALL SERVE AS MY DIRECTION THAT MY CREDIT REFERENCES PROVUDE MY CREDIT PERFORMANCE INFORMATION.

EVERYTHING THAT I HAVE STATED IN THIS APPLICATION IS CORRECT TO THE BEST OF MY KNOWLEDGE.  I UNDERSTAND THAT PROSPECTIVE CREDITORS WILL RETAIN THIS APPLICATION WHETHER OR NOT IT IS APPROVED.  I WILL NOTIFY PROSPECTIVE CREDITORS, IF APPLICABLE, WITHIN A REASONABLE TIME OF ANY CHANGE IN MY NAME, ADDRESS OR EMPLOYMENT.

CUSTOMER ACKNOWLEDGMENT *

I (we) acknowledge that I (we) received a copy of this notice and agree to the terms and conditions set forth on the date indicated below.

Applicant Electronic Signature: *

Today's Date:

10/04/2023