First Name:

Last Name:

Age:

Birth date (DD/MM/YY):

Marital Status:

Single    Married     Other

Address:

City/Town:

Province:

Postal Code:

Home Phone:

Work Phone:

E-mail:

Social Insurance Number:

Present Employer:

Occupation:

How Long Have You Worked Here:

Gross Monthly Income:

Current Property:

How Long Have You Lived At Current Address?:

Monthly Rent/Mortgage $:

Have you declared bankruptcy in the last 7 years?:

Have you ever had a vehicle repossessed?:

Please Rate Your Credit:

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

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.