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Address line 2

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This is the date you started your employment

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Address Line 2

City*

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Employer Address*

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Employer Zip*

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This is the date you started your employment

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I agree to give permission for the above applicant(s) Consumer Credit Report(s) to be obtained, at no cost to me, in order to help determine the types and extent of financing which are available*

In connection with your transaction, Twin Rivers Chrysler Jeep Dodge 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 Twin Rivers Chrysler Jeep Dodge Credit Application staff for the purpose of facilitating a relationship or business transaction.

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