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First Name *

Last Name *

Age

Birth Date (dd/mm/yy) *

Marital Status

Single Married Other

Adrress *

City/Town *

Province *

Postal Code *

Home Phone*

(10 digits)

Cell Phone

(10 digits)

Email*

Social Insurance No

Present Employer

Occupation

Gross Monthly Income

Years In Current Job

Current Property

Own Rent Live With Parents / Relatives

How Long Have You
Lived At Current Address?

Monthly Rent/Mortgage $

Have you declared
bankruptcy in the
last 7 years?

Yes No

Have you ever had
a vehicle repossessed?

Yes No

Please Rate Your Credit

Good Average Bad No Credit

If necessary, do you have
a Co-Signer for
your financing?

Yes No

Vehicle Desired #1

Vehicle Desired #2

Vehicle Desired #3

Down Payment Amount

Do you plan to
purchase/Lease
a vehicle within

Trade In?

Yes No

Trade Info?

Comments

Newsletter

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Disclaimer : By submitting this application you certify that each of the statements made and answers given in this credit application are true and correct and is made for the purpose of inducing the financing of the purchase of a motor vehicle. I authorize the obtaining of a consumer report to be used in evaluating this application and the obtaining and exchanging of credit information from and with other creditors and consumer reporting agencies.

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