Bedford Ford Lincoln Mercury

10050 State Road 37 South
Bedford, IN 47421
Phone: 812-279-8121
Fax: 812-275-2282

BEDFORD FORD LINCOLN MERCURY Financial Privacy Disclaimer

In connection with your transaction, we may obtain information about you as described in this notice, which we handle as stated in this notice.

1. We collect nonpublic personal information about you from the following sources:

Information that we receive from you on applications or other forms
Information about your transaction with us, our affiliates or others; and
Information we receive from consumer reporting 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 may not make such disclosures about you as a consumer, customer, or former customer.

3. We may also disclose nonpublic personal information about you as a consumer, customer or former customer, to nonaffiliated 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 to guard your nonpublic personal information.

Continue to Form

* Required

This secure form will start the credit verification process. Fields marked * are required.

Applicant Information

First Name *

Middle Initial

Last Name *

Suffix

Date of Birth (mm/dd/yyyy) *

Social Security Number *

Email *

Address *

City *

State *

ZIP *

Home Phone *

Housing Information

Length of Residence *

Housing Status *

Mortgage/Rent Amount *

Landlord or Mortgage Holder *

Previous Address *

Previous City *

Previous State *

Previous ZIP *

Previous Length of Residence *

Previous Rent or Mortgage Amount *

Employment Information

Employer *

Occupation *

Employer Phone *

Gross Monthly Income *

Time Employed *

Previous Employer *

Previous Occupation *

Previous Employer's Phone

Previous Gross Monthly Income *

Previous Time Employed *

Your Current Auto Loan

Make/Model

Signature & Privacy Statement

Signature *

Date (mm/dd/yyyy) *

* Required

By submitting this credit application, I verify that the information provided is complete and accurate to the best of my knowledge. I further authorize an investigation of my credit and employment history. I also accept the terms of the Privacy Policy.

Bedford Ford Lincoln Mercury • 812-279-8121 | Site Map • Disclaimer