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Vehicle Information
New/Used
Year*
Make*
Model
Anticipated Down Payment
$
 
Trade-In Information
Year
Make
Model
Mileage
Contact Information:( Information marked with an * is mandatory.)
Name*
Address*
City*
State*
Zip*
Country
Email Address 1
Birth Date*
Social Security No.*
Day Phone 1
Evening Phone 1
Fax
Preferred Contact Method
Current Employment
Company Name
Company Phone
Job Title
Start Date
Gross Income
How Often Paid

Number of years at this job

Previous Employment if less than 6 months at current employer
Company Name
Company Phone
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Call For More Information
Phone: 704-552-8522
Toll Free: 800-522-7365
sales@harrelsonmazda.com

Harrelson Mazda 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.