Birth
Date (Month/Day/Year):
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
Previous
Address: *if
less than 2 years at current address
Street#
Street Name:
Street Type
Alley
Alley
Autoroute
Avenue
Bay
Boulevard
Center
Chemin
Circle
Close
Cote
Court
Cove
Crescent
Dale
Drive
Estates
Expressway
Freeway
Garden
Gate
Green
Grove
Heights
Highway
Hill
Knoll
Lane
Line
Link
Loop
Mall
Manor
Mews
Montee
Oval
Parkway
Path
Pike
Place
Plaza
Point
Private
Promenade
Rang
Range
Rise
Road
Row
Rue
Run
Sentier
Square
Street
Terrace
Trail
View
Walk
Way
Length of time at previous
address:
Years
0
1
2
3
4
More than 4 years
Months
0
1
2
3
4
5
6
7
8
9
10
11
Telephone:
Work
Telephone:
Cell
Phone:
E
Mail:
SIN
Number:
*not
required but will help us speed up your application
-
-
Present
Employer:
Occupation:
How
Long:
Years
0
1
2
3
4
More than 4 years
Months
0
1
2
3
4
5
6
7
8
9
10
11
Gross
Monthly Income:
Monthly
Rent / Mortgage:
Have
you declared bankruptcy in the last 7 years?:
Please Select
Yes
No
Have
you ever had a vehicle repossessed?:
Please Select
Yes
No
If
necessary, do you have a Co-Signer for your financing?:
Please Select
Yes
No
Not Sure
Please
Rate Your Credit
Please Select
Good Credit
Average Credit
No Credit
Bad Credit
Vehicle
Desired:
Down Payment Amount:
Do you plan to
purchase/Lease
a vehicle within:
Please Select
1 Week
1 Month
3 Months
Trade
In?:
Please Select
Yes
No
Trade
Info:
Comments: