CREDIT INFORMATION:  Please fill out this cedit application. Print this application, fill it and sign it. Then, fax it to us at 519-579-7472 and we will call you as soon as we have the good news you've been approved.
Credit Applicaion
First Name Initial Last Name
Social Insurance Number Date of Birth    mm/dd/yy Marital Status
c   Married c   Single
c   Divorce c   Common Law
Spouse's First Name Initial Last Name (if different)
Spouse's Social Insurance Number Date of Birth    mm/dd/yy Marital Status
c   Married c   Single
c   Divorce c   Common Law
Current Adress (Number & Street Name) Apt # How long have you lived there?
City Province Postal Code Home Phone #(with area code) 999-999-9999
Name & Adress of Landlord of Mortgage Holder Monthly Payment c   Own              c   Rent
Previous Address (if changed in last 5 years) How long did you live there?
Employer Name & Address Employer Phone# 999-999-9999 Position Held
How Long ? Monthly Income c Gross  c  Net
Previous Employer Name & Address (if changed in last 5 years) Employer Phone# 999-999-9999 Position Held
Spouse's Employer Name & Address Employer Phone# 999-999-9999 Position Held
How Long ? Monthly Income c Gross  c  Net
Spouse's Previous Employer Name & Address (if changed in last 5 years) Employer Phone# 999-999-9999 Position Held
Total Monthly Family Income
Have you declared bankcruptcy in the last 5 years?                           c   Yes                    c     No
Have you had a car repossessed in the last 7 years?                         c   Yes                    c     No
BY SUBMITTING THIS APPLICATION I/WE AGREE THAT A PERSONAL INVESTIGATION MAY BE CONDUCTED AND / OR A CREDIT REPORT OBTAINED IN RESPECT OF THIS CREDIT APPLICATION.

Signed :______________________________                                       Signed :________________________________                                                      Date: __________________________