POTAMKIN MAZDA

7400 BIRD RD
MIAMI, FL 33155
Phone: 305-266-3500
Fax: 305-266-6577

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By clicking "Submit" I agree to the disclaimer below.

By submitting this application:
1. I authorize Dealer, Americredit and any finance company, bank, or other financial institution to which the Dealer or Americredit submits my application ("you" or "your") to investigate my credit and employment history, obtain credit reports, and release information about your credit experience with me as the law permits.
2. 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.
3. I certify that I have read and agree to the terms of this application and that the information in it is complete and true.
4. I authorize you to start a credit investigation based on the information voluntarily provided by me which is true and correct, and reflects all my current debts. In addition, I authorize you to obtain federal and state records of employment and income history, including State
Employment Security Agency ("SESA") records. This SESA authorization is for this transaction only and continues in effect for one (1) year unless limited by state law, in which case the authorization continues in effect for the maximum period, not to exceed one (1) year, as allowed by
law. A bankruptcy proceeding is not in progress nor expected. If the attached application is submitted in the name of a business, a current and year-end financial statement, including P&L statement, and balance sheet may be required, audited if possible.
5. IN EXCHANGE FOR YOUR TIME. EFFORT. AND EXPENSE IN REVIEWING MY APPLICATION AND FOR OTHER VALUABLE CONSIDERATION, WHICH IS HEREBY ACKNOWLEDGED. I AGREE TO ALL THE TERMS OF THE IMPORTANT CONTRACT OF ARBITRATION CONTAINED ON THE REVERSE SIDE OF THIS APPLICATION FORM AND ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND ALL OF ITS TERMS.