The Car Store

Name:*

Email:*

Phone Number:* (XXX) XXX-XXXX

Best time to Call: (weekdays 9-5pm)

Fax Number: (XXX) XXX-XXXX

Purchase Vehicle (Year, Make and Model):*

Trade Vehicle (Year, Make and Model):*

Price:*

GST:*

Trade:*

Cash Down:*

Balance To Finance:*

Buyer's Full Name:*

S.I.N.:

Date Of Birth:*

Address:*

City:*

Province:*

Postal Code:*

Phone:*

Employer:*

How Long?:*

Occupation:*

Gross Monthly Income:*

Employer Phone:*

Previous Employer:*

How Long?:*

Occupation:*

Gross Monthly Income:*

Employer Phone:*

Co-Buyers's Full Name:

S.I.N.:

Date Of Birth:

Employer:

Occupation:

Gross Monthly Income:

Phone:

How Long:*

Previous Employer:

Occupation:

Gross Monthly Income:

Phone:

How Long:

Own or Rent Home?:* - please select - own rent

Monthly Payments:*

Mortgage Holder:

Creditor Name:

Monthly Payment:

Amount Owing:

Creditor Name #2:

Monthly Payment #2:

Amount Owing #2:

Creditor Name #3:

Monthly Payment #3:

Amount Owing #3:

Have you been bankrupt?:* - please select - yes no

Have you ever had a vehicle repossessed?:* - please select - yes no

Have you ever had any late payments with creditors?:* - please select - yes no

If yes to any of the above, please explain:*

The buyer certifies that the information given in this application is true and authorizes the financial institution(s) to conduct a credit investigation and verify information given.

The seller certifies that the vehicle is free from all leins and that the vehicle is not written-off.