CREDIT APPLICATION  (RED TITLED BOXES REQUIRE INFORMATION)
 Vehicle Information
YEAR MAKE MODEL PRICE
$ 
Name of salesman

 Personal Information
SALUTATION
Mr Ms Miss Mrs  		HOME PHONE
()- 		EMAIL ADDRESS
FIRST NAME
 MIDDLE
   LAST NAME
  
AGE
 BIRTH DATE
 MARITAL STATUS
 SOC. INS. NO
DRIVERS LICENCE NO.
 PROV.

 NO. OF DEPENDANTS

 AGES (SEPARATE BY ,)

 Spouse's Information
FIRST NAME
 LAST NAME
 SOC. INS. NO
BIRTH DATE
 SPOUSE'S EMPLOYER
 ADDRESS
CITY
 PROV.

 EMPLOYER'S PHONE
()- 		  INCOME
$/YEAR
HOW LONG EMPLOYED
YRS MTHS

 Residence Information
 
PRESENT ADDRESS
ADDRESS
 CITY/TOWN
 PROV.

 POSTAL
 HOW LONG
(YRS/MTHS)
OWN/RENT Payment
PREVIOUS RESIDENCES
(if less than 2yrs at current residence)
ADDRESS
 CITY
 PROV.

 HOW LONG
(YRS/MTHS)
ADDRESS
 CITY
 PROV.

 HOW LONG
(YRS/MTHS)

 Employment Information
PRESENT EMPLOYER
NAME
 ADDRESS
 CITY
 PROV
HOW LONG
(YRS/MTHS)
 OCCUPATION
 WORK PHONE
()- 		INCOME
$/YEAR
RANK (IF MILITARY)
 DEPT. OR SUPV.
PREVIOUS EMPLOYER (if less then 2 years at present employer)
NAME
 ADDRESS
 CITY
 PROV
NAME
 ADDRESS
 CITY
 PROV
SOURCE OF OTHER INCOME
 Amount
$/YEAR

 Credit Information
 
CREDIT REFERENCES - Includes finance companies, banks, credit cards, change accounts. Indicate name(s) under which credit was obligated if other than above.
NAME OF CREDITOR/CREDIT CARD/APPLICANT   OPEN CLOSED
 
BAL. OWING IF OPEN DATE CLOSED IF CLOSED ORIGINAL BALANCE MO. PAYMT AMOUNT
$ $ $
NAME OF CREDITOR/CREDIT CARD/APPLICANT   OPEN CLOSED
 
BAL. OWING IF OPEN DATE CLOSED IF CLOSED ORIGINAL BALANCE MO. PAYMT AMOUNT
$ $ $
NAME OF CREDITOR/CREDIT CARD/APPLICANT   OPEN CLOSED
 
BAL. OWING IF OPEN DATE CLOSED IF CLOSED ORIGINAL BALANCE MO. PAYMT AMOUNT
$ $ $
BANK / SAVINGS & LOAN ACCT.
 BRANCH & ADDRESS
 TYPE OF ACCOUNT
SAVINGS CHEQUING
SAVINGS CHEQUING

By clicking Accept & Submit, you acknowledge that Keith Gordon Auto Sales is authorized to submit your personal information to financial institutions for the purposes of seeking credit approval(s). You further authorize the financial institutions to use this personal information to evaluate your credit worthiness for the purposes of obtaining financing approval.

At Keith Gordon Auto Sales we take your privacy seriously. Other than for the purposes stated above we will not share or disclose your personal information with anyone else nor will your personal information be stored kept or retained on our systems.

Note: This consent allows information on a spouse to be included in any report and that the applicant is at least 19 years of age.