Credit Application Form

Applicant Information
Title	First Name / Initial	Last Name	S.I.N.
Mr. Mrs. Ms. Miss.
Address	City	Province / Postal Code	Time At Address
			Years Months
Birth Date	Home Phone (xxx-xxx-xxxx) / Marital Status	Drivers License #	Expiry Date
Pick Date	Single Married Divorced Seperated Common Law		Pick Date
Other Photo ID Type	Other Photo ID #	Expiry Date	Email
		Pick Date
Employment Information
Name	Address	City	Province
Employment Duration	Occupation/Job Title
Years Months
Work Phone (xxx-xxx-xxxx)	Income per month (before taxes and other deductions)
Previous Employer (if less than 2 years ago)
Name	Address	City	Province
Employment Duration	Occupation/Job Title	Income per month (before deductions)
Years Months		/Month
Co-Applicant Information
First Name	Last Name	Social Insurance Number	Birth Date
			Pick Date
Spouse's Employer	Employer's Address	Employer's City	Employer's Province
Employer's Phone (xxx-xxx-xxxx)	Length of Employment	Income per month (before deductions)
	Years Months	/Month
Landlord/Mortgage Holder Information (If Band Housing Select Band from Housing Type)
Land Type / Rent-Mortgage Payment	Landlord/Mortgage Holder Name	Landlord Address	Landlord Phone
Select Rent Own Family Band Other /Month
If you are a Homeowner
Mortgage When Opened	Mortgage Currently Owing	Market Value of Home
Previous Address (if current address is less than 2 years)
Address	City	Province	Duration at Address
			Years Months
Trade-In Information
Year	Model	Mileage (kms)
I'm Looking For:	Available Down Payment	Desired Monthly Payment
Financial Information
Have you Declared Bankruptcy in the last 7 years?		If yes Date Discharged	Have you ever had a repossession?
Select Yes No		Pick Date	Select Yes No
Bank Name	Bank Address	Bank Phone
Account Type	Account Number	Balance
Select Chequing Savings
Additional Comments
Acknowledgement and Consent
By signing below, you affirm that the information you have given in this Application is true and complete and that you have not withheld any information. We will rely on the information you have given us to decide on your Application. You authorize us to give to, obtain, verify, share and exchange credit and other information about you and with others, including credit bureaus, and other persons with whom you may have financial dealings as well as any other person as may be permitted or required by law. you also expressly waive your right, where permitted by law, to receive a copy of any Financial Statements or Financing Change Statements registered under the Personal Property Security Act as a result of a loan made by us to you or any renewal or discharge thereof.