Consumer Application

Dealer Name: *

Phone No:

Rep:

Type of equipment description: *

New/Used: *
NewUsed

Year: *

Make:

Model:

Pre-Tax Cost($): *

Cash Down($):

Misc Fees($):

Trade in Equipment:

Equipment type:

Year:

Make:

Model:

Trade Value

Salutation: *
—Please choose an option—Dr.Mr.Ms.Miss.Mrs.

Gender: *
—Please choose an option—MaleFemale

Marital Status: *
—Please choose an option—MarriedCommon LowSingleDivorcedWidow/Widower

Email

First Name: *

Middle Name:

Last Name: *

Telephone: *

Cell phone:

Alt Phone:

Drivers License number:

Prov:

Expiry:

SIN - (Optional):

Date Of Birth

Street: *

City: *

Postal: *

Province: *

Duration: (Years) *

Duration: (Months): *

Home: *
Own with mortgageOwn free and clearOwn mobile homeRentWith parentsReserve housingOther

Type: *
—Please choose an option—At homeExecutiveLabourerManagementOffice StaffProductionProfessionalRetiredSalesSelf EmployedServiceStudentTradesUnemployedOther

Employer: *

Occupation: *

Duration (Years): *

Duration (Months): *

Status: *
—Please choose an option—Full timeFull Time ( probation )Part timePart time ( probation )Seasonal SummerSeasonal WinterSelf EmployedRetired

Telephone: *

Gross Income($): *

Per:
—Please choose an option—YearMonthWeek

Other Income Type:
—Please choose an option—Car AllowanceChild Support/AlimonyDisability PaymentsInvestment IncomePensionRental IncomeWorkers CompensationOther

Gross Income($):

Per:
—Please choose an option—YearMonthWeek

Borrower 2 ( Co-Applicant )

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