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* recommended fields.

Personal Information

*Applicant surname
(Co-applicant) surname

*Given names

(Co- applicant) given names

* Address/city/province

*Postal code
Duration

*Telephone

*Email Address (VALID EMAIL ADDRESS ONLY or your application will not be sent.)

Previous address/city/province

Postal code
Duration

Applicant employer
Position

Duration
Phone

Previous employer
Position

Duration
Phone

Co-applicant employer
Position

Duration
Phone

Personal reference/address

Relationship
Phone

Personal reference/address

Relationship
Phone

Bank/branch
Landlord/mortgage holder
Monthly rent/mortgage

Vehicle Requesting to Purchase

Make
Model
Term

Options
Year

Income Source

Source 1
Gross monthly income: $
Net monthly income: $

Source 2
Gross monthly income: $
Net monthly income: $

Source 3
Gross monthly income: $
Net monthly income: $

Total gross monthly income: $
Total net monthly income: $

Assets Liabilities

Property 1
Property 1 value: $
Mortgage holder
Owing: $
Monthly terms: $

Property 2
Property 2 value: $
Loans/Loc
Owing: $
Monthly terms: $

Auto
Auto value: $
Credit cards
Owing: $
Monthly terms: $

Other
Other value: $
Other
Owing: $
Monthly terms: $

Total assets: $
Total Liab.: $
Total terms: $

Comments

The undersigned is advised that the dealer intends to refer to a report from a credit reporting agency in connection with the conditional sale transaction and leasing proposed to be entered into by the undersigned with the dealer and the undersigned consents to the obtaining of such information from his or her present or any future employer and credit reporting agency or any other person as the dealer may require at the time in connection with such transaction and to the disclosure of any information concerning the undersigned to any credit reporting agency or any person with whom the undersigned has or proposes to have financial matters.

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