Finance Application

First Name:

Last Name:

Birth Date:

Social Insurance Number (not mandatory, but accelerates the process):

Email:

Telephone (including area code):

Best time to contact you:

Address:

City:

Province:

Postal Code:

At this address since (year):

CURRENT VEHICLE

Make:

Model:

Year:

Monthly Payment:

Balance Owing:

Financial Institution:

PRESENT EMPLOYER

Company Name:

Type of Work:

Since:

Telephone (including area code):

Gross Salary:

Gross Salary Per:

ADD SPOUSE

Last Name:

First Name:

Date of Birth:

Social Insurance Number (not mandatory, but accelerates the process):

OTHER SOURCE OF REVENUE

Specify:

Amount $:

Your Credit Comments?

I authorize the dealer to access my credit information in order to speed up the process of buying a vehicle:

We will contact you within 48 hours to discuss your application.

D.R. POLLEY USED CARS LTD.