Your Information:

First Name: Middle Initial 

Last Name:
Area Code: Phone: 
Marital Status: select one of the following: Married Unmarried Separated Divorced Widowed 
Actual  Address:
Mailing  Address:
City:  Prov: 

Postal Code:
How Long?: Years  Months
Monthly rent/mortgage:  

Do You:  select one of the following: Own House Own Condominium Own Mobile Home Rent House Rent Apartment Rent Mobile Home Live With Relatives 
SIN Number:  

Birth date (mm/dd/yy):  Age: 
Your email: 
Have you ever filed bankruptcy? 

 select one of the following: No Yes.. Discharged Yes.. Not Discharged 
Have you ever had a repossession? 

 select one of the following: No Yes 



Level Of Education:   select one of the following: University GraduateCollege Graduate Some College High School Graduate 

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About Your Work:

Company Name:

Company Address:

Company Area Code:

Phone #:

Immediate Supervisor:

How Long? YearsMonths
Monthly Gross Income: select one of the following: less then $750 $ 750-$1,000 $1,001-$1,500 $1,501-$2,000 $2,001-$3,000 $3,001-$3,500 $3,501-$4,000 $4,001-$5,000 $5,000-$6,000 $6,000- Above

*Source of other income, describe:

Amount of other income per month:

Anything about your income you wish to tell us?

*Alimony, child support, or separate, maintenance income is not required unless you choose to have such income considered regarding extension and repayment of the credit requested

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About Your Finances:
List your monthly payments that you pay out below.

In addition to Rent/Mortgage list all other debts including auto loans, credit cards, second mortgage, home . dues, alimony, child support, child care, medical utilities, auto insurance, Tax liabilities, etc. Please use a separate line for each credit card and auto loan.

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Credit line and Vehicle Requested:

What type of vehicle would you like:

 select one of the following: New Car New Truck New Custom Van New Sport Utility Used Car Used Truck Used Sport Utility Used Custom Van 



Vehicle model name: 



Approximate Amount requested: 

 select one of the following: less then $5,000 $5,000-$7,000 $7,001-$8,500 $8,501-$10,000 $10,001-$15,000 $15,001-$20,000 $20,001-25,000 $25,001 or more 



Amount of Down Payment: 

 select one of the following: Less then $500, Not Recommended $501-$1,000 $1,001-$1,500 $1,501-$2000 $2,000-$2,500 $2,501-$3,000 $3,000-or More 



Do you have a trade?  

Describe: 
Additional comments:

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I certify that statements on this application are true and complete. I authorize any person, association, firm or corporation to furnish, on request, to the Finance Department or its assigns, information concerning me or my affairs. Please inform me of the best possible terms available to me regarding the purchase of a motor vehicle. My confidentiality is extremely important and every care shall be taken to safeguard it. It is a crime to knowingly make a false statement on this or any application for credit.