Fax Application Form

Name (First & Last): _________________________________________

Age: ____________________________________________________

Birth Date: ________________________________________________

Marital Status:    Married    Single    Other

Address: __________________________________________________

City / Town : _______________________________________________

Province: _________________________________________________

Postal Code: _______________________________________________

Telephone: ________________________________________________

Work Telephone: ____________________________________________

Cell Phone: ________________________________________________

E Mail Address: _____________________________________________

SIN Number: _______________________________________________

Present Employer: ___________________________________________

Occupation: ________________________________________________

How Long: _________________________________________________

Gross Monthly Income: _________________________________________

Monthly Rent / Mortgage: _______________________________________

Have you declared Bankruptcy in the last 7 years?:    Yes    No

Have you ever had a vehicle repossessed?:    Yes    No

If necessary, do you have a Co-signer?:    Yes    No

Rate Your Credit:    Good    Average    None    Bad

Desired Vehicle 1: ____________________________________________

Desired Vehicle 2: ____________________________________________

Desired Vehicle 3: ____________________________________________

Down Payment Amount: ________________________________________

Do you plan to purchase/lease:    Now    Within 1 Month    Within 3 Months     Not Sure

Trade In?:    Yes    No

Trade Info: __________________________________________________

Promotional Code: _____________________________________________

Comments: __________________________________________________

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