Last Name:     First Name:     Initial

Social Security Number:     Birthdate:

Present Address(include route, box, apt#):   

City: State:     Zipcode:    

How long: Own Rent    Phone Number:

Previous Address(If less than 1 year at present):

City: State:     Zipcode:    
SPOUSE INFORMATION

Last Name:     First Name:     Initial:

Present Address(include route, box, apt#):

City: State:     Zipcode:    

How long:     Own     Rent     Other
APPLICANTS EMPLOYER

Employer     Address:

City: State:     Zipcode:    

How long:     Occupation:    

Gross Earnings:     Phone Number:    

Previous Empoyer:    

Address:    

City: State:     Zipcode:

How long:     Occupaton:    

Gross Earnings:     Phone Number:    

Other Income(from alimony, child support etc.):Monthly Amount:

How long:     Source:    

Name of nearest relative not living with you:

Address(include city,state,zip)

Phone Number:

JOINT APPLICANT INFORMATION

Last Name:     First Name:     Initial

Social Security Number:     Birthdate:

Present Address(include route, box, apt#):

City: State:     Zipcode:    

How long: Own Rent     Other Phone Number:

Previous Address(If less than 1 year at present):

City: State:      Zipcode:     
JOINT APPLICANT EMPLOYER

Employer Address:

City: State:     Zipcode:    

How long:     Occupation:

Gross Earnings:     Phone Number:

Previous Empoyer:

Address:

City: State:     Zipcode:    

How long:     Occupaton:

Gross Earnings:     Phone Number:

Other Income(from alimony, child support etc.):Monthly Amount:

How long:     Source:

Name of nearest relative not living with you:

Address(include city,state,zip)

Phone Number:
Transamerica Retail Financial Services Privacy Notice

This is the short form initial Privacy Notice of Transamerica Retail Financial Services. Consumers can obtain a copy of the complete Privacy Notice by calling us toll free at 1-800-854-6910. Consumers that become a customer of Transamerica Retail Financial Services will have the full Privacy Notice automatically sent to them. In either case, consumers and customers have the right to opt out of our sharing of their nonpublic personal information as described in the complete Privacy Notice.
OPT OUT CHOICE:
If you prefer that we do not disclose information about you to our affiliates and third parties, as described below, you can direct us not to make certain disclosures (that is, pot put of the disclosure) by calling us toll free at 1-800-854-6910 or writing to us at Transamerica Retail Financial Services, P.O. Box 14930, Lenexa, KS 66285-4930. An pot-out with respect to third party disclosures will apply only to nonpublic personal information that we would otherwise be able to share with types of third parties described in the complete Privacy Notice. An opt-out with respect to affiliates sharing will apply only to information collected for use by us or others in determining you eligibility for credit or other business transactions. In addition, opt-out of affiliate disclosures will not apply to information about transactions or experiences between you and our affiliates or us. For example, if you opt put of affiliate disclosures, we will not disclose to our affiliates income information that you provide on a credit application, or a credit report obtained from a consumer reporting agency. However, we still will be able to disclose information to our affiliates about you account balance and payment history with us. Please provide your installment contract number or application information if you choose to opt out. If you have a joint contract or application, an opt out by one participant on the contract or application will apply to all participants on the contract or application. Your choice to opt out of information sharing will apply only to the contract or application you specify when you opt out.

SIGNATURES I certify that everything I have stated in this application and on any attachments is true and correct. Transamerica Retail Financial Services Corporation (TRFS)< the administrator of this program may keep this application whether or not it is approved. By signing below I authorize TRFS to check my credit and employment history and to answer questions from and provide information to others about my credit record with TRFS. I understand that I must update credit information at TRFS's request if my financial condition changes. A consumer report may be requested in connection with this application or connection with updates, renewals or extensions of credit. Upon your request you will be informed whether or not a consumer report was requested and if so the name and address of this application or in connection with updates, renewals or extensions of credit. Upon your request you will be informed whether or not a consumer report was requested and if so the name and address of the agency that furnished such report.

Applicant's Signature: Date:

Joint Applicant's Signature: Date:

Joint Applicant DL# or State ID#: State: Expires: