I hereby declare I am applying for
a sales contract with US Credit Sales Inc. and/or one of
it’s partners, affiliates, or brokers/dealers under the
provision of Section 552a(b) Public Law 93-579, commonly
known as the Privacy Act, Dept. of Defense 5400.11 enc 5
Par3 - 2 apr 340 - 21 Dept. of the Army, 27 August 1975
Section C, Par 24 AFR 12-35, Dept. of the Air Force Par
7a(1), SECNABINST 5211.5 Dept. of the Navy 14 August
1975. I understand that my application may be submitted
to one or more lenders, partners, affiliates, or
brokers/dealers to obtain suitable financing for said
contract. I further understand that the Lender will not
contact my Commanding Officer in connection with this
debt unless I specifically give the Lender prior consent
to make such contact. With full knowledge and
understanding of this right, I hereby consent to
contacting my Commanding Officer/Personnel Officer
and/or Custodian of my official records to obtain my
current military and /or civilian address even though I
may be discharged and/or retired from military service.
I also consent to you contacting my Commanding Officer
in connection with the collection of the debt made
hereby at any time when it is in default and until such
time as the debt has been paid in full. *
I have read the above terms and I agree to them
* Indicates Response Required
The above statements are
true, and I further consent
to the release of the
pertinent information.
