Online Credit Application
Speed up your purchase or your lease by making an on-line credit check!
This is not an official document. We will contact you as soon as
the process is completed.
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| I
plan to buy (or lease) a vehicle in: |
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| Amount of deposit: |
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| Monthly payment required: |
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Personal Information |
| Name: |
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| Date of birth (year/month/day): |
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| E-mail: |
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| Phone (with area code): |
-
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| Fax (with area code): |
-
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| Address: |
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| City: |
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| Province: |
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| Postal Code: |
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| At this address since: |
years |
OWNER (if applicable) |
| Mortgage Institution: |
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| Phone (with area code): |
-
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| Account number: |
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TENANT (if applicable) |
| Name of landlord: |
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| Phone (with area code): |
-
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| Monthly Rent $: |
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OTHER (if
applicable)
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| Specify: |
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| Balance $: |
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| House Value $: |
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Present Employer |
| Company or Owner: |
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| How long (years,months): |
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| Position: |
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| Phone at work: |
-
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| Income $: |
(per annum) |
Previous Employer |
| Company or Owner: |
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| How long (years,months): |
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| Position: |
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| Phone at work: |
-
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2nd Previous Employer
|
| Company or Owner: |
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| How long (years,months): |
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| Position: |
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| Phone at work: |
-
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Other Source of Income |
| Specify: |
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| Amount $: |
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Assets, Other than above (Ex. RRSP's, Investments etc.) |
| Specify: |
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| Nature: |
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| Value $: |
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Bank Account Information |
| Bank Name: |
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| Address: |
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| Phone (with area code): |
-
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| Have you ever been bankrupt? |
No
Yes |
| Do you have a credit card? |
No
Yes |
| If yes, specify the type: |
Visa
Mastercard
Amex
Other |
Other Bank
Account Information |
| Bank Name: |
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| Address: |
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| Phone (with area code): |
-
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By submitting our credit application form you have authorized
Cobourg KIA to obtain a credit bureau on all information provided above.
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YES! I want to receive information on future contests, surveys,
special promotions and new content from "Cobourg KIA". |
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