Credit Application Form

About you

Vehicle of Interest :	2006 Chevrolet Uplander LS (ID: 202 Stock Number: 10095C)
Full Name / Middle Initiale (first name,last name) :
Date of Birth (month/date/year) :
Social Insurance Number (optional - speeds approvals) :
Email:
Home Phone (including area code) :
Best Number to Contact You on Between 9 to 5
Address:
City:
Province:
Postal Code:
How long at this address? (years/months) :
If less than 2 years
How long at Previous address? (years/months) :
I am an:	Owner Owner with Mortgage Renter
Mortgage Holder/Landlord Name
Market Value
Bank Name
Monthly Payment/Rent: (if applicable)
Shared with Others?	Yes No

Employment History

Place of Employment:
Type of Work:	Full Time Part Time Contract Temporary Invalidity Total Invalidity Maternity Leave Self-Employed
How Long have you been on this Job? (years/months) :
Position held:
Telephone (including area code) :
Employer's address
Address:
City:
State:
Zip:
Can We Contact You at Work?	Yes No
Gross Weekly Income (before taxes) :
Commission:
If less than 3 years
How Long at Previous Employer (years/months):
Same Line of Work?	Yes No

Additional sources of income

Specify Source 1:
Amount $:
Specify Source 2:
Amount $:

Credit History

Describe the nature of your credit problem? (if applicable)

Current Budget

How much of a down payment do you have for buying or leasing a vehicle?
What is your budget for a monthly car payment?
Do you have a vehicle you are trading in?	Yes No
If so Please Describe Your Trade in
Trade in Year:
Trade in Make:	(Ford, Nissan, KIA, GM, Dodge, etc.)
Trade in Model:	(Taurus, Focus, F-150, Neon, Sentra etc.)
Trade in Kilometers:
Trade in Comments: (if applicable)

Disclaimer

PLEASE READ By submitting this form, you certify that all of the statements in this application are true and complete and are made for the purpose of obtaining credit. You authorize any dealer or lender who receives this application to retain it, to rely on it and to obtain such other information as it may require, including credit reports. You also confirm that you have read the Privacy Policy and the User Agreement Sections. This hereby authorizes the dealers to obtain a credit bureau on all information provided above. All false declarations will result in the automatic refusal of the credit application.

If required, would a consigner be available?

Yes No