New Customer’s Form

Consent to Screening

By clicking the checkboxes and Submit, I agree that (i) provide my authorization and written instruction to Dealer and its successors, assigns and agents to perform a “soft” credit report pull (which inquiry will not affect my credit score) from one or more credit bureaus and to obtain any other information deemed necessary or helpful, in accordance with the federal Fair Credit Reporting Act and other applicable state and federal laws, for the purpose of analyzing my potential creditworthiness for motor vehicle financing (“Request”). I acknowledge that I may be contacted by the Dealer and understand that this Request process does not guarantee a final result nor final credit approval by any lender. For example, credit scores below lender established thresholds may not produce any result. In such situations, I understand that I may be requested to submit a full credit application with the Dealer. The results of the Lender Selector^® screening are not offers of credit.

I confirm that (i) I have read, understand and agree to the Dealership Privacy Policy, Consent to Contact by Telephone, and Electronic Consent, Signature and Terms and will retain a copy of the same for my record and (ii) my name as entered in the Electronic Signature below is accurate. Finally, I understand that (i) a copy of the Dealership Privacy Policy and Electronic Consent, Signature and Terms will be provided to me by SMS link or emailed to me, as appropriate, and (ii) a “hard” credit pull (which may affect my credit) may be made if a credit application is submitted with any lenders Certified Autobrokers works with.

Check the box below to submit your inquiry

Signature Form

Customer Name
Date
I have read, understood and agree to the Dealership Privacy Policy*
- I read, understood and agree to the Dealership Privacy Policy Dealership Privacy Policy
Consent to Contact by Telephone

Consent to Contact by Telephone

By providing your telephone number to us, you agree that this action constitutes an “inquiry” for purposes of telemarketing laws. Regardless of the fact that your telephone and/or mobile number may be listed with the Federal Do-Not-Call Registry or your State Do-Not-Call list, you are providing your express written consent to receive future information (including services) from the Dealer, and you hereby agree and consent to our contacting you using the information you have provided and will provide to us. This means we may contact you by phone and/or mobile number, text (SMS) message, or any other means of communication that your wireless or other telecommunications device may be capable of receiving (e.g., video, etc.). You are not required to agree to this consent in order to obtain Services through us. This consent may be revoked by you at any time and by any reasonable means, including by emailing us at support@selectfi.com and putting the words “remove my telephone number” in the subject line of your email, or by telephoning us at 1 (716)-529-4660.
Consent to Contact by Telephone*
- I read, understood and agree to Consent to Contact by Telephone
Electronic Consent, Signature and Terms

Electronic Consent, Signature and Terms

You are submitting a request for screening for the purpose of analyzing your creditworthiness for motor vehicle financing (“Request”) through Certified Autobrokers and its agents (“we,” “us,” or “our”). We can only provide you the benefits of this service by conducting business through the Internet. To do this, we need your consent to transacting electronically and receiving certain disclosures electronically. By completing and submitting a Request through us, you acknowledge receipt of this document, agree to be bound by its terms, and consent to the electronic delivery of the Privacy Policy, this document and any other disclosures provided in connection with your Request (“Disclosures”).

We are not a creditor or loan broker. The purpose of the Request process is to produce a best-estimate of potential credit offers that may be available to you based on (i) certain known and estimated credit offer-related data concerning lenders with whom we have working relationships and others, (ii) information that you may provide, (iii) information provided by third parties such as credit reporting bureaus and your motor vehicle manufacturer and (iv) certain dealer-defined variables. While this Request process is intended to be as accurate and predictive as possible, lenders’ credit underwriting and credit approval requirements are constantly changing. Consequently, this Request process is not a substitute for a current (real-time) credit decision of an actual lender based on a formal application for financing. You may choose to submit a formal credit application after completing the Request process. If you choose to proceed, you direct us to deliver, on your behalf, any information gathered in connection with the Request process to your selected lender and you assume all responsibility for the accuracy of such information.

Scope of Consent:

Your consent to receive Disclosures and to do business electronically, and our agreement to do so, applies to the Lender Selector^® program including but not limited to, Request results, disclosures and our recordkeeping. Before you decide to do business electronically with us, you should consider whether you have the required hardware and software capabilities described in this document. To obtain a paper copy of any of the Disclosures, you may write to: Certified Autobrokers
1693 Grand Island Blvd, Grand Island, NY 14072 with the details of your request. Paper copies will be provided to you at no charge.

It is a condition of submitting a Request that all the information you provide in connection with such Request is correct, current, and complete, and you represent and warrant that all information that you provide in connection with submitting a Request is correct, current, and complete, and can be relied upon by us.

Reliance on Information:

Any information presented by us, including, without limitation, on or through the Disclosures, is made available solely for general information purposes. We do not warrant the accuracy, completeness, or usefulness of this information. Any reliance you place on such information is strictly at your own risk. We disclaim all liability and responsibility arising from any reliance placed on such materials by you, or by anyone who may be informed of any of its contents.

The results of this Request process may include content provided by third parties, including materials provided by third-party licensors, syndicators, aggregators, and/or reporting services. We are not responsible or liable to you or to any third party, for the content or accuracy of any materials provided by any third parties.

Hardware and Software Requirements:

To access and retain the Disclosures electronically, you will need to use the following computer software and hardware: Internet Explorer 4.0 or above, Netscape Navigator 4.0 or above or equivalent software; and hardware capable of running this software. We may update these hardware and software requirements at any time, and without further notice to you. If you are unable to access the Disclosures because of outdated hardware or software, you must update your hardware or software to the latest requirements. If you refuse to update your hardware or software, you may be unable to access the Disclosures or any Request-related information that we may provide.

Withdrawing Consent:

Your consent is voluntary, but we cannot process your Request if you do not consent. If you are unwilling to receive disclosures electronically, do not select the “I agree” box or provide your electronic signature. If you provide your electronic consent now and decide to withdraw your consent later, the legal validity and enforceability of prior electronic Disclosures will not be affected.

Changes to Your Contact Information:

You should keep us informed of any change in your electronic or mailing address. You may contact Certified Autobrokers regarding any such changes.

CONSENT:

BY COMPLETING AND SUBMITTING YOUR REQUEST, YOU CONSENT TO HAVING ALL DISCLOSURES PROVIDED OR MADE AVAILABLE TO YOU IN ELECTRONIC FORM AND TO DOING BUSINESS WITH US ELECTRONICALLY. YOU FURTHER ACKNOWLEDGE THAT YOU CAN ACCESS AND, IF NECESSARY, RETAIN THE ELECTRONIC DISCLOSURES IN THE DESIGNATED FORMATS DESCRIBED ABOVE.

Electronic Signature:

You are signing this Request electronically. You agree that your electronic signature is the legal equivalent of your manual/handwritten signature on this Request. By selecting "I Agree" using any device, means or action, you consent to the legally binding terms and conditions of this Request. You further agree that your signature on this Request (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification, authority or other third party verification is necessary to validate your E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and us. You are also confirming that you are the individual authorized to enter into this Request. You further agree that each use of email equates to your E-Signature and constitutes your agreement to be bound by the terms and conditions of this Request as they exist on the date of your E-Signature on this Request.

1021-001 62392
rev. 4/15/24
Electronic Consent*
- I read, understood and agree to the Electronic Consent, Signature and Terms
Signature*
Email
This field is for validation purposes and should be left unchanged.

Customer Information

Dealership Store

Dealership Officer

First Name This field is required

Middle Name This field is required

Last Name This field is required

Suffix

Phone This field is required

Email This field is required

Address This field is required

Apartment, suite, etc. (optional) This field is required

City This field is required

State This field is required

ZIP This field is required

Date of Birth This field is required

Time with Current Employer

Social Security Number This field is required (numbers only)

Confirm Social Security Number This field is required

Have You Ever Filed for Bankruptcy?

Additional Information

Residency Status This field is required

Housing Status This field is required

Mortgage or Rent Amount This field is required $

Time at Current Address

This field is required years This field is required months

Previous Address

Address This field is required

Apartment, suite, etc. (optional) This field is required

City This field is required

State This field is required

ZIP This field is required

Time at Previous Address

This field is required years This field is required months

Current Employment

Status This field is required

Employer Name This field is required

Occupation This field is required

Work Phone This field is required

How much do you make per year? This field is required $

Time at Current Job

This field is required years This field is required months

Address This field is required

City This field is required

State This field is required

ZIP This field is required

Previous Employment

Status This field is required

Employer Name This field is required

Occupation This field is required

How much do you make per year? This field is required $

Time at Previous Job

This field is required years This field is required months

Other Income

Other Monthly Income Source This field is required

Other Monthly Income Amount This field is required $

Alimony, child support, or separate maintenance does not need to be revealed if you do not want it considered when repaying this obligation.

Consent and Disclosures

Please review the consent and disclosure notice and click the required box(es) to continue your application.

CONSUMER NOTICES BY STATE

Notice to California Residents: IF MARRIED YOU MAY APPLY FOR CREDIT SEPARATELY AS AN INDIVIDUAL.

Notice to Maine, Rhode Island, and Tennessee Residents: You must have physical damage insurance covering loss or damage to the vehicle for the term of any contract. For a lease, you must also have the liability insurance described in the lease. You may buy this insurance from anyone you choose. You do not have to buy it from someone affiliated with the dealer or an assignee of this contract. Your choice of insurance will not affect the credit approval process unless the insurance does not satisfy the contract requirements or the insurance company does not satisfy the reasonable standards of the dealer or an assignee of the contract.

Notice to New Hampshire Residents: If you are applying for a balloon payment contract, you are entitled, if you ask, to receive a written estimate of the monthly payment amount for refinancing the balloon payment in accord with the creditor’s existing refinancing programs. You would be entitled to receive the estimate before you enter into a balloon payment contract. A balloon contract is an installment sale contract with a final scheduled payment that is at least twice the amount of one of the earlier scheduled equal periodic installment payments.

Notice to New York Residents: Consumer reports may be requested in connection with this application. Upon request, you will be informed whether or not a consumer report was requested and, if it was, of the name and address of the consumer reporting agency that furnished the report. Additional consumer reports may be requested with respect to any extension or renewal of this obligation.

Notice to Ohio Residents: The Ohio laws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio civil rights commission administers compliance with this law.

Notice to Rhode Island: Consumer reports may be requested in connection with this application.

Notice to Wisconsin Residents:
Please Indicate:
[ ] Married
[ ] Unmarried (includes single, divorced, widowed)
[ ] Separated

If married or separated and spouse is not a co-applicant please provide:

Non-applicant spouse name: ________________________________________
Non-applicant spouse’s address: ______________________________________

Notice: The interest of the creditor will not be adversely affected by a provision of a marital property agreement, a unilateral statement under Wisconsin Statutes § 766.59 or a court decree under Wisconsin Statutes § 766.70, unless you furnish a copy of such agreement, statement or decree to the creditor, or the creditor has actual knowledge of such provision before credit is granted.

NON-APPLICANT SPOUSE'S WAIVER OF NOTICE: I agree to waive notice of any extension of credit in connection with this application.
Non-applicant spouse signs (if available) ___________________________ Date __________

By clicking the "Submit" button:

I authorize Certified Autobrokers and any finance company, bank or other financial institution to which the dealer submits my application (“you”) to investigate my credit and employment history, verify my income, obtain credit reports, and release information about your credit experience with me as the law permits.

I further authorize you to forward my application and all related information to other creditors for evaluation as a method of effectuating my request for credit.

I certify that I have read and agree to the terms of this application and that the information in it is complete and true.

Check the appropriate box to indicate Individual Credit or Joint Credit.

Individual Credit - I am applying for individual credit in my own name and relying on my own income or assets and not the income or assets of another person as the basis for repayment of the credit requested.

Joint Credit – I am applying intentionally for joint credit with another person.

I certify that I have read and received the above state disclosures.

By clicking this box, I agree that this credit application is an electronic credit application submitted using electronic means and such means signifies my intent to submit this credit application to Certified Autobrokers to the same extent as if I had executed the credit application using my written signature.

Consent to pull the Credit Bureau Report and apply for Credit Application on my behalf

Request for More Information

Based on the name and address you provided, we are unable to locate your credit file information. To continue, please provide your SSN and click “Try Again” to continue with the pre-qualification process.

As a reminder this does not log a hard inquiry on your credit file or affect your credit score and we do not store or share your SSN.

Skip

Additional Information

How much do you make per year? This field is required $

Thank you for submitting your information.

We are preparing financing estimates for your vehicle. We will contact you shortly.

Consent to Screening

Signature Form

Consent to Contact by Telephone

Electronic Consent, Signature and Terms

Scope of Consent:

Reliance on Information:

Hardware and Software Requirements:

Withdrawing Consent:

Changes to Your Contact Information:

CONSENT:

Electronic Signature:

Customer Information

Additional Information

Previous Address

Previous Employment

Consent and Disclosures

Please review the consent and disclosure notice and click the required box(es) to continue your application.

CONSUMER NOTICES BY STATE

Check the appropriate box to indicate Individual Credit or Joint Credit.

Request for More Information

Additional Information

Thank you for submitting your information.

Salesperson Sending Form