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Where Did You Hear About Us (please be specific)?
Email Address
PERSONAL INFORMATION
Salutation
First Name
Initial
Last Name
Social Insurance Number
Mr.
Mrs.
Ms.
Miss.
-
-
Birth Date
Home Phone
Cell Phone/Other Phone
Marital Status
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
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15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
(
)
-
(
)
-
Single
Married
Divorced
Separated
Common Law
RESIDENCE INFORMATION
Present Address
Address
City
Province
Postal Code
Duration at Address
AB
BC
MB
NF
LB
NB
NT
NS
ON
PE
PQ
SK
YT
Years
Months
Type
Rent/Mortgage Payment
Landlord/Mortgage Holder
Landlord/Mortgage Holder Phone
Rent
Own
Family
Other
$
(
)
-
If you are a Homeowner
Mortgage When Opened
Mortgage Currently Owing
Market Value of Home
$
$
$
Previous Address
Address
City
Province
Duration at Address
AB
BC
MB
NF
LB
NB
NT
NS
ON
PE
PQ
SK
YT
Years
Months
EMPLOYMENT INFORMATION
Present Employer
Name
Address
City
Province
AB
BC
MB
NF
LB
NB
NT
NS
ON
PE
PQ
SK
YT
Employment Duration
Occupation/Job Title
Work Phone
Gross Monthly Income
Years
Months
(
)
-
$
Previous Employer (if less than 2 years ago)
Name
City
Employment Duration
Years
Months
Source Of Other Income
Income Per Month $
CO-APPLICANT INFORMATION
First Name
Last Name
Social Insurance Number
Birth Date
-
-
Jan
Feb
Mar
APR
May
Jun
Jul
Aug
Sept
Oct
Nov
DEC
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Present Employer
Name
Address
City
Province
AB
BC
MB
NF
LB
NB
NT
NS
ON
PE
PQ
SK
YT
Employment Duration
Occupation/Job Title
Work Phone
Gross Monthly Income
Years
Months
(
)
-
$
Previous Employer (if less than 2 years ago)
Name
City
Employment Duration
Years
Months
Source Of Other Income
Income Per Month $
TRADE-IN INFORMATION
Model
Year
Mileage (kms)
Desired Vehicle
Available Down Payment
Desired Monthly Payment
$
$
COMMENTS (optional)
Acknowledgment and Consent
I/We certify that the above information is complete and accurate to the best of my/our knowledge. I/we further certify that I/we have attained the age of majority. Creditors receiving this application will retain the application whether or not is approved. Creditors may rely on this application in deciding whether to grant the requested credit. False statements may subject me to criminal penalties. I/we authorize the creditors to obtain credit reports about me/us on an ongoing basis during this credit transaction and to check my/our credit and employment history on an on going basis during the term of the credit transaction. If this application is approved, I/we authorize the creditor to give credit information about me/us to its affiliates.
