Please supply the following information, making sure it is accurate and complete. An accurate e-mail address and correct phone numbers are required to communicate the results of your application. Once you've completed this page, please read the advisory paragraph at the bottom of the page for your information. When ready, click on the "Submit" button. Please note that all fields with black column headings denote mandatory entry.

STEP 1: Personal Information
First Name    Middle Initial    Last Name
 
Social Insurance Number    Birth Date
month day year
 
Street Number    Street Name
 
Suite / Apt Number    P.O. Box    R.R. Number
 
City    Province    Postal Code

 
How long have you lived at the above address?
years   months  
Mortgage/Rent Amount  
 
Home Telephone Number
 
Email Address
 
Is there a co-applicant? (not available in Quebec)
Yes No

STEP 2: Employment and Income Information
Occupation
(If applicable, indicate whether you're a student, retiree, or unemployed)
Employer    How long have you worked there?
years   months
Work Telephone Number
Gross Monthly Income
*Income should reflect income before taxes.
Other Monthly Income    Source of Other Income*
*Source of other income: alimony, child support or separate maintenance income need not be disclosed if you do not wish to have it considered as a basis for repaying this obligation.

STEP 3: Vehicle Selection
Year Make Model Model Desc(eg.LE)
Kilometers Engine Transmission Other


STEP 4: Financing Information
Would you like to Lease or Finance      Term   Kilometers Per year
 

STEP 5: Miscellaneous
 
Have you ever had a repossession or bankruptcy? Yes No
If Yes, when?  
What bank do you do business with?  
 
Amount of Outstanding Debt:  
Credit Card Company          Amount  
Credit Card Company          Amount  
Personal Loan - Company   Amount  
Line of Credit - Company    Amount  
Credit limit on Line of Credit                                                        
 
Monthly Payment Range: From   To  
Down payment: From   To  

Trade-in information (if applicable)
Estimated Value  Year Make Model
Mileage Condition Is your trade-in Balance/Amount Owed
Good
Fair
Poor		 Owned
Financed
Leased
 
A consumer/personal report containing credit, medical or personal information will be referred to in connection with this application and upon clicking the "Submit" button, the above applicant hereby consents to the preparation of such a report, and the consumer further consents to the Credit/Financial Institution obtaining credit, medical or personal information reports representing the applicant from consumer reporting agencies

The above applicant hereby consents and acknowledges that the Credit/Financial Institution and/or its successors or assigns shall have the right to disclose any information contained in a consumer/personal report on the applicant to other credit grantors or consumer reporting agencies in its own discretion or upon referral of the applicant.
NOTE: This consent allows information on a spouse to be included in any report.