ABOUT YOU

First Name* Middle Name Last Name*

Email* Date Of Birth* Address*

City* Province* Postal Code *

ProvinceALBERTABRITISH COLUMBIAMANITOBANEW BRUNSWICKNEWFOUNDLANDNOVA SCOTIANW TERRITORIESONTARIOPRINCE EDWARD ISLANDQUEBECSASKATCHEWANYUKON

Home Phone* Mobile Phone SIN

Residential Type * Time at Current Address*

Residential TypeOwnRentLive with Parents

EMPLOYMENT/INCOME INFORMATION

Employment Status* Employer* Position*

Employment Status Full-time Part-time Disability Self-employed Retired

Work Phone* Length Of Employment* Monthly Earnings (before tax)*

Other Monthly Income Amount Source of Other Income (if applicable)

HOW CAN WE HELP?

Application Type* Loan Amount Requested Maximum Monthly Payment*

Application Type Vehicle Financing Vehicle Repair Loan Motorcycle Financing Leisure Financing

Maximum Down Payment Amount Available* Trade-in Available Vehicle Desired

Trade-in Available Yes No

ABOUT YOUR CREDIT

Credit History Previous Repo.

Credit History Good Credit Bad Credit Bankruptcy New Credit

Previous Repo Yes No

Have You Previously Been Declined? Co-signer Available?

Have You Previously Been Declined? Yes No

Co-signer Available? Yes No

ALMOST DONE! A COUPLE MORE QUESTIONS...

How Did You Hear About Us? Who Referred You (if applicable) Dealership Name

How Did You Hear About Us? Radio Kijiji Referral Website Google

I hereby certify that the information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the amount and conditions of the credit to be extended. Furthermore, I hereby authorize the financial institutions listed in this credit application to release necessary information to the company for which credit is being applied for in order to verify the information contained herein. I have read the Private Policy.