SECTION 1

    Full Name:

    Address:

    Are you over 19?

    Is the vehicle free and clear of all financial obligations?

    No:why?

    Are you the sole owner of the vehicle?

    No:name of other?

    How much cash do you require? in $

    How long do you require the loan for?

    SECTION 2

    Insurance Registration No:

    Plate:

    VIN:

    Make:

    Model:

    Body Style:

    Year:

    Color:

    Odometer:

    Transmission:

    Any damage in excess of $2,000.00, or has a rebuilt Engine?

    Yes:what?

    Is there collision insurance coverage on the vehicle?

    How much is the collision deductible? (in $)

    Insurance Expiry Date:

    SECTION 3

    Driver's License Number:

    BC / AB:

    Expiry Date:

    Date of Birth:

    SIN:

    Eye Color:

    Home Phone:

    Email:

    Hair Color:

    Cell:

    Work Phone:

    Height:

    Employer:

    Martial Status:

    Weight:

    Job Title:

    Address:

    Spouse/Partner's Name:

    Address if different from yours:

    Phone:

    SECTION 4

    Relatives Information:

    Name:

    Phone:

    Name:

    Phone:

    Friends Information:

    Name:

    Phone:

    Name:

    Phone:

    Preferred Monthly Payment Method