[ back ]                                                    Credit Information

Please Print this page, fill it out and then sign it. When completed, fax it to us at 519-744-1638. We will call you as soon as we have the good news.  We will keep all the information confidential. 
Name:__________________________________________________________________________ Birthdate (M/D/Y)____________
Address_________________________________________________________________________ Sin #______________________
_______________________________________________________________________________ How Long__________________
Previous Address:__________________________________________________________________ How Long__________________
_______________________________________________________________________________ Martial Status_______________
Home Phone #___________________Work Phone #_____________________________________ Driver's License______________
Mort/Rent Payment:_______________Mort. Amt._______________________________________ Property Value______________
Mortgage/Landlord Name____________________________________________________________ Phone #___________________
Employer_______________________Address:__________________________________________
Job Title:_______________________Job Tittle:_________________________________________ Gross Income Monthly________
Previous Employer:________________________________________________________________ How Long__________________
Additional Income:________________________________________________________________
Debts, Credit Cards Etc._____________________________________________________________
Bank:___________________________________________________________________________ Branch Acc.#_______________
Have you been declined for credit?______YES / NO_________WHY?_________________________
_______________________________________________________________________________
Vehicle Info - Year________________________________________________________________ Serial #____________________
Make:_________________________Specific Model:______________________________________
New/Used_____KMs_____________ Options:___________________________________________
Selling Price:____________________Cash Down/Trade:___________________________________
Amount To Finance:_______________Term____________________________________________ Max Mon. Payments__________
Black Book Price:________________Clean/Avg_________________________________________
I certify that the above information accurate, and I authorize an investigation
of my credit history and the release of information about my credit experience.
 
Date:______________Signature:_______________CO-Signature__________________
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