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REQUIRED *
$ Purpose
of Loan*
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you hear about us?*
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US ABOUT YOURSELF E-mail
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Address*
City*
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Zip*
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of Years at Current Address*
If
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Zip
Amount
of Rent/*
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Take Home Pay*
$ *
how often? Weekly Bi-Weekly Monthly Previous
employer (if less then two years with current employer)
Previous Employer
Occupation
Employer's Address
City
State
Zip
Work Phone (###)
###-####
Number of Years and
Months employed there
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INCOME (Alimony,
child support or separate maintenance income need not be revealed if you do not
wish to have it as a basis for repaying this obligation. )
Other Income Amount
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US ABOUT YOUR VEHICLE Year
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By
IMPORTANT
NOTICE The
Federal Equal Opportunity Act prohibits creditors from discriminating against
credit applicants on the basis of race, color, religion, national origin, sex,
marital status, age (provided the applicant has the capacity to contract), income from a public assistance program, or having made a
good faith complaint under the Consumer Credit Protection Act. If credit is denied,
applicant is entitled to a statement of reason for such action from the creditor
within 30 days. The federal agency which administers compliance with this law
concerning this creditor is the Federal Trade Commission, Washington, D.C. 20580.
We may report about your account to credit bureaus. Late payments, missed payments or other defaults on your account may be reflected in your credit bureau report information.
Your
privacy is important to us. You may obtain a copy of the Nationwide Privacy Policy
by calling us at 800-622-7605. As permitted by law, we may share information about
our transactions and experiences with you with other companies affiliated with
Nationwide and unaffiliated third parties including consumer reporting agencies
and other creditors. However, we may not share with companies affiliated with
Nationwide 1) other information (such as from your application or consumer report
or from other third parties) or 2) any personal information (including transaction
and experience information) for marketing purposes; if you tell us not to share
this information. To limit sharing information with our affiliates 1) except as
permitted by law and/or 2) for marketing purposes, you can notify us by calling
1-773-777-7600 or by writing to: Nationwide, 3435 N. Cicero Ave., Chicago, IL
60641. Please include your name, address and social security number so that we
can honor this request.
You certify
that the foregoing statements are true and complete and made for the purpose of
determining your eligibility for credit. You agree that this application shall
remain our and our assignees' property, whether or not credit is extended. We
and our assignees are authorized to make all inquiries we deem necessary to verify
the accuracy of the statements made herein, and to determine your creditworthiness
by obtaining consumer reports from consumer reporting agencies and credit information
from others, including financial institutions, extenders of credit, references,
present and former employers, merchants, landlords and creditors. You agree that
we and our assignees may contact you in writing, by e-mail, or using prerecorded/artificial
voice messages, text messages, and automatic telephone dialing systems, as the
law allows. You also agree that we and our assignees may contact you in these
and other ways at any address or telephone number you provide us, even if the
telephone number is a cell phone number or the contact results in a charge to
you. Pursuant to the Fair Credit Reporting Act, you are notified that your credit
application may be submitted to Nationwide (or one of Nationwide's affiliates)
for consideration for the extension of credit. (Must
be checked before application is submitted!)