Pre-Approval Application Form

Personal InformationBBA510 First Name   Middle Name   Last Name Date of Birth (M / D / Y)                Select a Month January February March April May June July August September October November December  /        /       Marital Status:   Home Phone#   Cell#   Single     Married    Divorced    Common Law      (   )               ( )    Email Address:   Present Address:     Rent       Own City:     Province:      Postal Code:     How long?     Payment/Month? (Rent/Mrg)   If renting Landlord or Company Name:   Landlord or Company Phone Number:     previous address if less than 2 years    Previous Address:    City:   Province:    Postal Code:       Occupation Information Self employed? Yes No Company Name:   Occupation:   Part time Full Time Years at present job:    years    months   Gross monthly income: $     Work phone #   If less than 2 years at present employer,   previous company Name: Address: Previous Employer's Phone Number     Contact Name:   Years at previous job:    years    months   Gross monthly income at previous job: $   Other source of income: (name the source)     Other Source of income amount:$   How soon do you need a vehicle:   within a week more than a week      SIN Number:   Have you ever filed bankruptcy? No Yes   if yes, date of discharge Can you provide a cosigner if its necessary?   Yes     No                 Do you provide us authorization to proceed with this application   Yes     No           Terms and Conditions By checking this box, I consent to the collection, use and disclosure of my personal information as described in this paragraph. I agree that the personal information provided above may be used and disclosed by Dealership and/or its agents or service providers (collectively, the "Dealer") as necessary to obtain credit, financial and related personal information (including a credit or consumer information report) about me from any credit bureau or credit reporting agency, and to advise me on credit availability in connection with vehicle purchase financing.Personal information I provide and credit information obtained may also be retained by Dealer and used to facilitate the application process should I subsequently choose to apply for credit through Dealer.