Consumer Credit Application

Fields marked with * are required. All information is kept strictly confidential.

Section 1 — Applicant Information

Last Name*

First Name*

Initial(s)

Date of Birth*

Social Insurance Number*

Section 2 — Spouse Information

Last Name of Spouse

First Name

Initial(s)

Date of Birth

Social Insurance Number

Section 3 — Home Address

Home Address*

City*

Province*

Postal Code*

How Long?

Own or Rent

OwnRent

Home Phone

Cell Phone*

Email Address*

Section 4 — Mortgage / Rent

Rent/Mortgage Payment ($/month)

Mortgage Amount ($)

Market Value ($)

Mortgage Holder

Section 5 — Previous Address

Previous Address

City

Province

Postal Code

How Long?

Section 6 — Employment

Employed By*

City

Province

Postal Code

Telephone No.

How Long?

Annual Salary ($)*

Position / Title

Person to Contact at Employer

Other Income ($)

Previous Employer

Previous Position

How Long at Previous Employer?

Section 7 — Spouse's Employment

Spouse's Employer

How Long?

Position

Telephone No.

Salary ($)

Section 8 — Banking

Name of Bank*

City

Province

Postal Code

Telephone No.

Account Number / Contact

Section 9 — Monthly Credit Payments

Including all credit cards, car payments/loans, lines of credit etc.

Description	Balance ($)	Monthly Payment ($)

Section 10 — Personal References

Reference 1

Name

Relationship

Address

City

Home Telephone

Reference 2

Name

Relationship

Address

City

Home Telephone

Reference 3

Name

Relationship

Address

City

Home Telephone

Section 11 — Driver's License

Driver's License Number*

Province*

Expiry Date (MM/YYYY)

Date of Issue (MM/YYYY)

By submitting, you consent to Vehicle Direct Group reviewing your application.