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Address Line 2

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Employer Zip*

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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*

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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 Eau Claire Chrysler Dodge Jeep Ram Credit Application staff for the purpose of facilitating a relationship or business transaction.

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