Credit Application

CONTACT INFORMATION

Salutation * Mr Mrs Ms Miss Dr

First Name *

Last Name *

Phone Number *

Email Address *

CURRENT HOME ADDRESS

Address Type * Street Rural Route Postal Box

Street Number *

Street Name *

City *

Province * Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Postal Code *

Years at address *

Months at address *

PERSONAL INFORMATION

Date of Birth *

Marital Status * Divorced Married Common Law Widow/Widower Separated Single

Gender *

Male

Female

HOUSING & EMPLOYMENT

HOUSING INFORMATION

Home Status * Own with mortgage Own free and clear Own Mobile Home Rent With parents Reserve Housing Other

Monthly Housing Payment *

Mortgage Amount *

Mortgage Holder *

Market Value *

CURRRENT EMPLOYMENT INFORMATION

Employment Status * Full Time Full Time (Probation) Part Time (casual) Part Time (regular) Retired Seasonal Summer Seasonal Winter Self Employed

Employment Type * At Home Executive Labourer Management Office Staff Other Production Professional Retired Sales Self-Employed Service Student Trades Unemployed

Employer *

Occupation *

Work Contact Phone *

Work Contact Ext. *

Years at address *

Months at address *

Address Type * Street Rural Route Postal Box

Street Number *

Street Name *

Street Type AbbeyAcresAlleeAlleyAutorouteAvenueBayBeachBendBLVDBoulBypassCampusCapeCarreCenterCervleChaseCheminCircleCircuitCloseCommonConcessionCornersCoteCourCoursCourtCoveCresentCroissantCrossingCul-de-sacDaleDellDiversionDownsDriveEndEsplanadeEstatesExpresswayExtensionFieldFreewayFrontGardensGateGreenGroundsHarbourHeathHeightsHighlandsHighwayHillHollowIleImpasseInletIslandKeyKnollLandingLaneLimitsLineLinkLookoutLoopMallManorMazeMeadowMewsMonteeMountMountainParadeParcPlateauPlazaPointPointePrivatePromenadeQuaiQuayRampRangRangeRidgeRiseRoadRouteRowRuelleRunSentierSquareStreetSubdivisionTerraceTerrasseTownlineTrailTurnaboutValeViewVillageVillasVistaVoieWalkWayWharfWoodWynd

City *

Province * Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon

Postal Code *

CURRENT INCOME INFORMATION

Income Amount *

Income Frequency * Year Month Week

Other Income Amount

Other Income Frequency Year Month Week

Other Income Type Car Allowance Child Support/Alimony Disability Payments Investment Income Pensions Rental Income Workers Compensation

Other Income Description

CO-APPLICANT

CO-APPLICANT INFORMATION

Add a co-applicant

Yes

No

Relation to primary applicant * Spouse Common Law Employer In-Law Parental Grandmother Grandfather Brother Sister Other

Loan & Asset

FINANCING INFORMATION

Financed Amount

Term 12 24 36 48 60 72 84

Cash Down

Monthly Payment

I have a Trade-In

Yes

No

DESIRED PURCHASE

If the vehicle you are looking for is not listed, please enter it manually in the comments section.

Asset Type Automotive Marine Leisure Recreational Vehicle

VIN / HIN / Serial no

Stock Number

ADDITIONAL INFORMATION

Sales Rep.

Referral Source AutoHound AutoTrader Family/Friend Internet Newspaper/Flyer Other (Please Specify) Radio Television

Please Specify *

Comments & Feedback

Disclosure & Privacy Notice

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 Mobile Trailer Repair Service 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 product and/or service purchase financing. I further agree that the personal information provided above may be disclosed to the provider of Dealer’s website hosting or related services for the purpose of enabling Dealer to access my personal information for marketing purposes. 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.