Applicant Information

First Name*

Last Name*

Phone #*

Email Address*

Date of Birth*

Social Security #*

Residence Information

Street Address*

Address 2

City*

State*

Zip Code*

Living Since (MM/DD/YYYY)*

Rent or Own?*

Monthly Payment/Rent*

Driver License Info

Driver's License #*

Driver's License State

Contact

Preferred Contact Method

Co-Applicant Information

First Name*

Last Name*

Phone Number*

Email Address*

Date of Birth*

Social Security*

Residence Information

Street Address*

Address Line 2

City*

State*

Zip Code*

Living Since (MM/DD/YYYY)*

Rent or Own?*

Monthly Payment/Rent*

Driver License Info

Driver's License*

Driver's License State*

Primary Applicant Employment Information

Employer Name*

Occupation or Job Title*

Employment Type*

Monthly Income before Taxes*

Employee Since*

Additional Income

Other Monthly Income Amount

Other Income Source

Co-Applicant Employment Information

Employer Name*

Occupation or Job Title*

Employment Type*

Monthly Income before Taxes*

Employee Since*

Additional income

Other Monthly Income Amount

Other Income Source

In connection with your transaction, Net Direct Lifted Trucks may acquire information about you as described in this notice, which we handle as stated in this notice.

We may collect personally identifiable information such as name, postal address, telephone number, e-mail address, social security number, date of birth, etc. This personal information is collected and used by Dealerfire Credit Application staff for the purpose of facilitating a relationship or business transaction.

Our website resides behind a firewall and uses SSL (Secure Sockets Layer, the industry-standard security protocol used to communicate with browsers) to transmit personal information. Data is strongly encrypted during transmission to ensure that personal and payment information is secure. Industry-standard data encryption techniques are used to protect personal information.

Co-Applicant Financing