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Applicant Info
First Name
Middle Name
Last Name
SIN
Phone #
Date of Birth
Gender
Male
Female
Marital Status
Single
Married
Common Law
Home Status
Own
Rent
With Parents
Address
Street name and Number
Postal Code
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Quebec
Saskatchewan
Yukon
Years
Months
Employment
Self Employed?
Yes
No
Employer Name
Occupation
Street name and Number
Postal Code
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Quebec
Saskatchewan
Yukon
Phone #
Years
Months
Financial Details
Rent / Mortgate
Property value
Total Gross Monthly Income
Have you ever declared bankruptcy?
Yes
No
Have you ever declared a consumer proposal?
Yes
No
Have you ever declared an involuntary automotive repossession?
Yes
No
Vehicle Details
Dealership Name
Vin #
Year
Current KMs
Make
Model
Color
Series
Body Style
Purchase Details
Cash Price before Tax
Cash Down
Extra Charges
Trade In
Yes
No
Trade In Value
Trade In Description
Lien?
Yes
No
Lien Amount
Lien Holder
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