FINANCE APPLICATION

FINANCE APPLICATION

Contact Us

Contact Us

Name (Nombre)*

SOURCE OF INCOME

fuente de ingresos primaria

BANK ACCOUNT INFORMATION

 Información de banco

CREDIT CARD INFORMATION

The debit/credit card information provided will be used to make your initial payment

Cardholders full name (Titular de la tarjeta)

Two relatives not living with you( Dos relativos que no viven con usted)

Relative 1 (Relativo 1)

Relative 2 (Relativo 2)

Acknowledgment

By clicking 'SUBMIT', I acknowledge that I am signing this Application electronically, and that my electronic signature is the legal equivalent of my written signature on the Application. I consent to be bound by the terms and conditions and important disclosures of the Application. I further understand that I am requesting that “Texas Tires, its partners or its subsidiaries” enter a payment plan agreement with me. I hereby: Certify that all information I have provided or will provide is true, correct, and complete; Consent to receive the disclosures contained in the Application electronically; Consent to “Texas Tires, its partners or its subsidiaries” contacting any person or company listed on my application to obtain information about me and fully release all parties from any claim that may arise out of such contact; Authorize “Texas Tires, its partners or its subsidiaries” to charge any credit or debit card (as described in the Application) in the amount of my Initial Payment if my application is approved and I execute a Payment Plan agreement with “Texas Tires, its partners or its subsidiaries” authorizing such a charge; Agree that “Texas Tires, its partners or its subsidiaries” may obtain one or more consumer reports ('Consumer Reports') in connection with either (a) my application, (b) any updates, renewals, or extensions of any transaction resulting from my application ('Transactions'), (c) the review or collection of any Transaction and (d) other legitimate business purposes related to any Transaction; Understand that upon my request (a) I will be informed whether “Texas Tires, its partners or its subsidiaries” obtained Consumer Reports and, if so, the name and address of the individual or company that furnished the Consumer Reports; Authorize “Texas Tires, its partners or its subsidiaries” to share information with the merchant whose goods I am interested in buying ('Dealer') about “Texas Tires, its partners or its subsidiaries” decision to offer me a payment plan, and authorize “Texas Tires, its partners or its subsidiaries” to share my application information and lease terms with Dealer; and understand that I can withdraw my consent by closing this web session without submitting my application.

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