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
  A consumer / personal report containing credit medical or personal information will be referred to in connection with this application and upon clicking the 'Apply' button the applicant herby consents to the preparation of such a report, and the consumer further consents to the Credit/Financial Institute obtaining credit, medical or personal information reports representing the applicant from consumer reporting agencies.

The applicant herby consents and acknowledges that the Credit/Financial Institute and/or its successors or assigns shall have the right to disclose any information contained in a consumer/personal report on the applicant to other credit grantors or consumer reporting agencies in its own discretion or upon referral of the applicant.

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.