Dealer Information
Selling Dealer Dealer Contact Person Phone Number
Email Address for current application this email will be used for communication.


Desired Payment Range
Per Month From Per Month To Desired Term
Additional Notes

Buyer
Legal First Name Legal Middle Name Last Name
SIN# Date Of Birth (YYYY-MM-DD) Home Phone Number
Cell Number email Street Address
City
Postal Code Province
Residence Type Own Rent Other At Residence Since
Rent/Mortgage   Previous address if less than 2 years at current
Additional Notes

Buyer Employment Information
Employer Name Occupation Employment Start Date
Business Phone # Gross Annual Income Other Annual Income
Describe Other Income Previously Bankrupt? Yes No Customer Bank
Previous Employer if less than 2 years at current
Best Number To Call Home Work Cell
Work Address

Buyer Assets / Liabilities  - Mortgage, Loans, Credit Cards
Asset Description and Bank Asset Value Original Balance Balance Owing Minimum Monthly Payment

Co-Buyer
Legal First Name Legal Middle Name Last Name
SIN# Date Of Birth (YY-MM-DD) Home Phone Number
Cell Number Street Address Postal Code
City Province Customers Work Address
Residence Type
Own Rent Other At Residence Since
Rent/Mortgage   Previous address if less than 2 years at current
Additional Notes

Co-Buyer Employment Information
Employer Name Occupation Employment Start Date
Business Phone # Gross Annual Income Other Annual Income
Describe Other Income   Best Number To Call Home Work Cell
Previous Employer if less than 2 years at current
  Customer Bank

Co-Buyer Assets / Liabilities  - Mortgage, Loans, Credit Cards
Asset Description and Bank Asset Value Original Balance Balance Owing Minimum Monthly Payment

Application Agreement:

I certify that the information I have given on this form is correct.  I am applying for a loan from the Seller to purchase a chattel as described in the Seller's bill of sale  The Seller will be referring this application to a Financial Institution because the Seller intends to assign this loan to the Financial Institution, if my loan is approved.  This loan is a separate transaction from the purchase; my obligation to make loan payments will not be affected by any dispute that may arise between me and the Seller.
THE SELLER AND THE FINANCIAL INSTITUTION MAY FROM TIME TO TIME GIVE ANY CREDIT AND OTHER INFORMATION ABOUT ME, INCLUDING ANY INFORMATION ON THIS FORM, TO, OR RECEIVED SUCH INFORMATION FROM: (A) ANY CREDIT BUREAU OR REPORTING AGENCY; (B) ANY PERSON WITH WHOM I HAVE OR PURPOSE TO HAVE FINANCIAL DEALINGS; AND (C) ANY PERSON IN CONNECTION WITH ANY DEALINGS I HAVE OR PROPOSE TO HAVE WITH THE DEALER OR FINANCIAL INSTITUTION.
I agree that the Financial Institution may use that information to establish and maintain my relationship with it and to offer me any services as permitted by law.

If there is a "Buyer" and "Co-Buyer", all references on this document to "I", "me" and "my" apply to both

 

I verify that all of the information provided above are correct.





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