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Personal Information

Current Address

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By submitting this application form, you certify that the information you have provided herein is true and correct to the best of your knowledge. You also authorize the Bank/Birchwood Chevrolet Buick to conduct a personal investigation, and by submitting this, you accept as notice in writing of and authorize the obtaining of any information required that may be relating to this application, from any source to whom the Bank/Birchwood Chevrolet Buick may apply and each source is authorized to provide the Bank/Birchwood Chevrolet Buick with information. In addition, you authorize the Bank/Birchwood Chevrolet Buick to disclose, in response to direct inquiries from any other lender or credit bureau, any information concerning your loan and account that the Bank/Auto Dealer considers appropriate and agreement is made to release the Bank/Birchwood Chevrolet Buick and save it harmless from any claims, damages or otherwise arising from such disclosure made by the Bank/Birchwood Chevrolet Buick.