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*Salutation

*First Name

*Last Name

*Birth Date

*Phone

*Email

*Marital Status

*Postal Code

*Home

*Street Address

*City

*Province

*Duration

Monthly Rent Payment

Name of Landlord

*Street Address

*City

*Province

*Duration

Down payment amount

Plan to purchase / lease a vehicle within

Desired Vehicle Make

Desired Vehicle Model

Desired Vehicle Year

Desired Vehicle Vin

*Employment Type

Social Insurance Number

*Occupation

*Present Employer

*Phone

*Employer Address

*City

*Province

*Postal Code

*Gross Income

*Duration

Previous Employer

*Duration

Have you declared bankruptcy within the past 7 years?

Have you ever had a vehicle repossessed?

If necessary, do you have a co-signer for your financing?

*Please rate your credit

*Duration

Have trade-in vehicle?

Year

Make

Model

Mileage (in KM)

Vehicle Description