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First Name*

Last Name*

Email Address*

Phone #*

Street Address*

Address line 2

City*

State*

Zip Code*

Date of Residency*

This is the date you started living are your current residence

Monthly Rent/Mortgage*

Social Security #*

Date of Birth*

Employment info

Employer Name

Employer Phone #

Date of Employment

This is the date you started your employment

Gross Monthly Income*

Additional Income

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Year

Make

Model

Trim

Total Loan Amount*

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Authorization for the Social Security Administration to Disclose Your Social Security Number Verification. I authorize the Social Security Administration (SSA) to verify and disclose to MobilityOne Financial and Mazda Financial Services through SentiLink, their service provider, for the purpose of applying for a vehicle loan whether the name, Social Security Number (SSN) and date of birth I have submitted matches information in SSA records. My consent is for a one-time validation within the next 364 days. If you sign this credit application electronically, you intend that process to be your electronic signature on an electronic application, acknowledge receipt of all disclosures provided on the credit application, and give your authorization and consent to the recipient(s) of this application to take the actions identified in the credit application, including for SSA to disclosure your SSN Verification to MobilityOne Financial, Mazda Financial Services and SentiLink.*

In connection with your transaction, Sky Mazda Odessa 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 Sky Mazda OdessaCredit 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.

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