2011 FORD F-250 SUPER DUTY LARIAT

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Residence
Present Address

Vehicle
Vehicle Interested In

Trade-In Vehicle

Additional Info
Banking Information

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STATE LAW DISCLOSURES

CA Applicants: IF MARRIED YOU MAY APPLY FOR CREDIT SEPARATELY AS AN INDIVIDUAL.

ME Applicants: 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 as 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 the contract you enter into. 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 you enter into.

NH Residents: If you are applying for a balloon payment contract, you are entitled to receive, upon request and before entering into the balloon contract, a written estimate of the monthly payment amount for refinancing the balloon payment in accord with the creditor's existing refinance 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.

NY Applicants: 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.

OH Applicants: The Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy 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.

RI Residents: Consumer reports may be requested in connection with this application.

VT Residents: If an account is created, you authorize the obtaining of credit reports for purposes of reviewing or taking collection action on the account or for other legitimate purposes associated with the account.

Notice to Married WI Residents: No provision of any marital property agreement, a unilateral statement under Wis. Stat. § 766.59 or a court decree under Wis. Stat. §766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision when the obligation to the creditor is incurred. The credit being applied for, if granted, will be incurred in the interest of my marriage or family. I understand that the creditor may be required by law to give notice of the credit transaction to my spouse.

FAIR CREDIT REPORTING ACT DISCLOSURE: This application may be submitted to the following financial institutions: Credit Acceptance, P.O. Box 551888, Detroit, MI 48255.

Acknowledgements
By clicking Submit, you (the applicant and each co-applicant): (1) certify that the information you provided is complete, true and accurate; (2) authorize us and financial institutions to whom we submit your application (hereinafter “Finance Sources”) to obtain consumer credit reports and to gather employment history as necessary and appropriate to determine your creditworthiness; (3) understand that we, the Finance Sources, or our assignees (collectively, “Creditors”) will retain this application whether or not it is approved. You also agree that each Creditor may monitor and record telephone calls regarding your account to assure the quality of our service or for other reasons; and may contact you in writing, by e-mail, or using prerecorded/artificial voice messages, text messages, and automatic telephone dialing systems, while servicing or collecting your account, as the law allows, using the telephone number(s) that you provide in this credit application, you provide in the future, or that a Creditor may obtain from another source, even if the number is for a mobile telephone and/or our using the number results in charges to you.