Name
First
Last
Date of Birth
Month
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Day
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Social Insurance Number
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Marital Status
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Address
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Province
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Home Phone
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Cell Phone
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)
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E-mail
Alternate/Work E-mail
Employer
Employer Phone
(
)
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Ext
Employer Fax
(
)
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Job Title or Occupation
Time with Current Employer
Years
Months
Gross Income (Before Deductions)
Monthly
Bi-Weekly
Weekly
Yearly
Additional Monthly Income (Before Deductions)
Source of Additional Income
Click Here if less than 2 years with current employer.
Previous Employer
Previous Employer Phone Number
(
)
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Time with Previous Employer
Years
Months
Click Here if you have a Spouse or Co-Signer.
Name
First
Last
Date of Birth
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
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SIN #
-
-
E-mail
Alternate/Work E-mail
Cell Phone
(
)
-
Employer
Employer Phone
(
)
-
Ext
Employer Fax
(
)
-
Job Title or Occupation
Time with Current Employer
Years
Months
Gross Income (Before Deductions)
Monthly
Bi-Weekly
Weekly
Yearly
Twice/Month
Additional Income (Before Deductions)
Source of Additional Income
Previous Employer (if less than 2 yrs with Current)
Previous Employer Phone Number
(
)
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Time with Previous Employer
Years
Months
Down Payment ($)
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$0
$500
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$2,500+
Down Payment
Right Now
?
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Do you have a Trade-In?
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Do you still owe on it?
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Year
Make
Model
Kilometers (Approx)
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Terms and Conditions
By submitting this application form, you certify that the information you have provided herein is true and correct to the best of your knowledge. You also authorize the Bank/Auto Dealer to conduct a personal investigation, and by submitting this, you accept as notice in writing of and authorize the obtaining of any information required that may be relating to this application, from any source to whom the Bank/Auto Dealer may apply and each source is authorized to provide the Bank/Auto Dealer with information. In addition, you authorize the Bank/Auto Dealer to disclose, in response to direct inquiries from any other lender or credit bureau, any information concerning your loan and account that the Bank/Auto Dealer considers appropriate and agreement is made to release the Bank/Auto Dealer and save it harmless from any claims, damages or otherwise arising from such disclosure made by the Bank/Auto Dealer.
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