First Name:

Last Name:

Birth Date (Month/Day/Year):

Month January February March April May June July August September October November December Day 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 Year 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996

Marital Status:

Single   Married    Other

Address:

Street#  Street Name:

Street Type Alley Autoroute Avenue Bay Boulevard Center Chemin Circle Close Cote Court Cove Crescent Dale Drive Estates Expressway Freeway Garden Gate Green Grove Heights Highway Hill Knoll Lane Line Link Loop Mall Manor Mews Montee Oval Parkway Path Pike Place Plaza Point Private Promenade Rang Range Rise Road Row Rue Run Sentier Square Street Terrace Trail View Walk Way

Length of time at this address:

Years 0 1 2 3 4 More than 4 years   Months 0 1 2 3 4 5 6 7 8 9 10 11

City / Town:

Province:

Please Select Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territories

Postal Code:

Telephone:

Work Telephone:

Cell Phone:

E Mail:

SIN Number: *not required but will help us speed up your application

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Present Employer:

Occupation:

How Long:

Years 0 1 2 3 4 More than 4 years   Months 0 1 2 3 4 5 6 7 8 9 10 11

Gross Monthly Income:

Monthly Rent / Mortgage:

Have you declared bankruptcy in the last 7 years?:

Please Select Yes No

Have you ever had a vehicle repossessed?:

Please Select Yes No

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

Please Select Yes No Not Sure

Please Rate Your Credit

Please Select Good Credit Average Credit No Credit Bad Credit

Vehicle Desired:

Down Payment Amount:

When do you plan to Purchase/Lease a vehicle:

Please Select 1 Week 1 Month 3 Months

Trade In?:

Please Select Yes No

Trade Info:

Comments: