Credit Application

855-771-9443
6171 Johnston St, Lafayette, LA 70503

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This secure form will start the credit verification process. Fields marked * are required.

Applicant Information

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First Name *

Last Name *

Birth Date *

Social Security Number *

Phone *

Email *

Address *

City *

State *

Zip *

Housing Information

Current Residence Duration *

Housing Status *

Mortgage Payment *

Mortgage Holder *

Previous Residence Address *

Previous Residence City *

Previous Residence State *

Previous Residence Zip *

Previous Residence Duration *

Employment Information

Employer Name *

Job Title *

Employer Phone *

Gross Income

Previous Employer Name *

Previous Job Title *

Previous Employer Phone

Previous Gross Income *

Make/Model

Signature

Signature *

Date *

Hampton Mitsubishi Financial Privacy Disclaimer
In connection with your transaction, we may obtain information about you as described in this notice, which we handle as stated in this notice.

1. We collect nonpublic personal information about you from the following sources:
Information that we receive from you on applications or other forms
Information about your transaction with us, our affiliates or others; and
Information we receive from consumer reporting agency
2. We may disclose all of the information we collect, as described above, to companies that perform marketing services on our behalf or to other financial institutions with whom we have joint marketing agreements. We may not make such disclosures about you as a consumer, customer, or former customer.
3. We may also disclose nonpublic personal information about you as a consumer, customer or former customer, to nonaffiliated third parties as permitted by law.
4. We restrict access to nonpublic personal information about you to those employees who need to know that information to provide products or services to you. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information.

Mitsubishi-stacked-white-on-transparent-100

Hampton Mitsubishi
(855) 771-9443

6171 Johnston St
Lafayette, LA 70503