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Stork Auto
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BUSINESS INFORMATION
Business Name
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Tax ID Number
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Street Address
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City
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State
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If you have lived at your current address for less than 3 years, please enter your previous address into the fields below.
Previous Address with Postal Code
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Idaho
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Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
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Utah
Vermont
Virginia
Washington
West Virginia
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How Long?
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Mortgage Amount
Bank Name and Branch
*
Account Number
*
Contact Person
*
Bank Phone
*
CO-APPLICANT - PERSONAL INFORMATION
First Name
*
Last Name
*
Date of Birth mm/dd/yy
*
Social Security #
*
Home Phone #
*
Street Address
*
City
*
State
*
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Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
How Long?
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Years
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Months
0
1
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3
4
5
6
7
8
9
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Own or Rent?
*
Own/Buying
Rent/Lease
Live With Relative
Other
Monthly Payment
*
If you have lived at your current address for less than 3 years, please enter your previous address into the fields below.
Previous Address with Postal Code
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
CO-APPLICANT - EMPLOYMENT
Employer Name:
*
Position / Title:
*
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Gross Annual Salary
*
Work Phone:
*
Other Income
Yes
No
(If Yes) Income Source
Annual Amount
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
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CONFIRMATION
E-mail Address
*
Contact Number
*
Notes/Comments
Privacy Policy
IN CONNECTION WITH YOUR TRANSACTION STORK AUTO 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 * 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 STORK AUTO 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.
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