PALMEN MOTORS INCORPORATED WebApplyOne

RouteOne Disclosure Wisconsin Resident
For the Applicant, please indicate: Marital Status:
If married or separated: Non-applicant Spouse's First Name: Last Name:
Non-applicant Spouse's Address: City: State: ZIP:
Notice: No provision of a marital property agreement, a unilateral statement under s. 766.59 or a court decree under s. 766.70 adversely affects the interest of a 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.

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

RouteOne Disclosure Wisconsin Resident
For the Co-Applicant, please indicate: Marital Status:
If married or separated: Non-applicant Spouse's First Name: Last Name:
Non-applicant Spouse's Address: City: State: ZIP:
Notice: No provision of a marital property agreement, a unilateral statement under s. 766.59 or a court decree under s. 766.70 adversely affects the interest of a 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.

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 PALMEN MOTORS INCORPORATED to the same extent as if I had executed this credit application using my written signature.

By clicking this box, I confirm that the co-applicant agrees that this credit application is an electronic credit application submitted using electronic means and such means signifies the co-applicant�s intent to submit this credit application to PALMEN MOTORS INCORPORATED to the same extent as if the co-applicant had executed this credit application using the co-applicant�s written signature.

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.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents.

By clicking the 'Apply for Financing' button, I agree that you, your affiliates, agents and service providers may monitor and record telephone calls regarding my account to assure the quality of your service or for other reasons. I also expressly consent and agree to you, your affiliates, agents and service providers using written, electronic or verbal means to contact me as the law allows. This consent includes, but is not limited to, contact by manual calling methods, prerecorded or artificial voice messages, text messages, emails and/or automatic telephone dialing systems. I agree you, your affiliates, agents and service providers may do so using any e-mail address or any telephone number I provide, now or in the future, including a number for a cellular phone or other wireless device, regardless of whether I incur charges as a result.

By clicking the 'Apply for Financing' button, I authorize PALMEN MOTORS INCORPORATED and any finance company, bank or other financial institution to which the dealer submits my application ("you") to investigate my credit and employment history, 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. If an account is created, I authorize you to obtain credit reports for the purpose of reviewing or taking collection action on the account or for other legitimate purposes associated with the account. I certify that I have read and agree to the terms of this application and that the information in it is complete and true.

This is an application for joint credit with another person.

We intend to apply for joint credit.

By clicking the 'Apply for Financing' button, I agree, and I confirm that the co-applicant agrees, that you, your affiliates, agents and service providers may monitor and record telephone calls regarding our account to assure the quality of your service or for other reasons. I also expressly consent and agree, and I confirm that the co-applicant consents and agrees, to you, your affiliates, agents and service providers using written, electronic or verbal means to contact us as the law allows. This consent includes, but is not limited to, contact by manual calling methods, prerecorded or artificial voice messages, text messages, emails and/or automatic telephone dialing systems. I agree, and I confirm that the co-applicant agrees, you, your affiliates, agents and service providers may do so using any e-mail address or any telephone number we provide, now or in the future, including a number for a cellular phone or other wireless device, regardless of whether we incur charges as a result.

By clicking the 'Apply for Financing' button, I authorize, and I confirm that the co-applicant authorizes, PALMEN MOTORS INCORPORATED and any finance company, bank or other financial institution to which the dealer submits our application ("you") to investigate our credit and employment history, obtain credit reports, and release information about your credit experience with us as the law permits. I further authorize, and I confirm that the co-applicant authorizes, you to forward our application and all related information to other creditors for evaluation as a method of effectuating our request for credit. If an account is created, I authorize, and I confirm that the co-applicant authorizes, you to obtain credit reports for the purpose of reviewing or taking collection action on the account or for other legitimate purposes associated with the account. I certify that the co-applicant and I have read and agree to the terms of this application and that the information in it is complete and true.