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Application Form	All * fields are Mandatory
PERSONAL INFORMATION
First Name* :
Middle Name :
Last Name* :
Gender :
Marital Status :
Date of Birth :
Home Phone* :
Cell Phone :
Work Phone :
Email Address* :
Who do you bank with?
Are you currently in bankruptcy?	Yes No
Have you had repossession in the last 12 months?	Yes No

HOME/MORTGAGE DETAILS
Address :
City :
Province :
Postal Code :
How long have you lived there?
Less then 2 years, list previous address :

Do you rent or own your residence?
Monthly Payment :
Market value of your residence?
Mortgage amount?
Mortgage holder or landlord’s name :

CURRENT EMPLOYMENT DETAILS
Are you self-employed?	Yes No
Occupation :
Employer :
Employer Address :
City :
Province :
Work Phone :
Extension :
How long have you worked there?
Less then 2 years, list previous employer :

INCOME DETAILS
Gross monthly income before deductions :
Other Income :
Car Allowance Amount (if applicable) :
Description of Other Income :

VEHICLE QUESTIONS
What type of vehicle would you like?
Price Range :
Are you planning to trade in a vehicle?	Yes No
Year & Make :
Do you have a down payment?	Yes No
Approximately how much?
When is the best time of the day to contact you?
At what phone number?
Does the dealership have permission to obtain your credit report?	Yes No
Social Insurance Number :
Do you have a valid drivers license?	Yes No
Do you have a consigner?	Yes No
How soon do you need a vehicle?
Where did you hear about us?

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Application Form