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.