FINANCE FORM - PART 1 of 2

Your Personal Information

Vehicle You Are Interested In:

First Name:* Middle Name: Last Name:*

Date of Birth:(mm/dd/yyyy)* Married:*

YES NO

Mailing Address:*

City/Town:* Province:* Postal Code:* Time at Address:*

Phone Number:* Alternate Phone Number: SIN#:

Your Financial Information

Employment

Occupation:*

Employer's Name:*

Employer's Mailing Address:*

City/Town:* Province:* Postal Code:*

Employer's Phone Number:* Your Time at Your Current Job:*

Type of Employment:*

Seasonal Full-Time Part-Time

Gross Monthly Income:(before tax)*

Residence

Rent or Own Your Dwelling:*

Rent Own Family Other

Landlord / Finance Institution: Rent/Mortgage Per Month:*

Bankruptcy

Have You Ever Declared Bankruptcy?:*

YES NO