CW AutoKing Financial Solutions
Credit Application
Applicant Information
Title
First Name
Initial
Last Name
S.I.N.
Mr.
Mrs.
Ms.
Miss.
Address
City
Province
Postal Code
Time at Address
AB
BC
MB
NF
LB
NB
NT
NS
ON
PE
PQ
SK
YT
Years
Months
Birth Date
Home Phone (xxx-xxx-xxxx)
Marital Status
Drivers License #
Expiry Date
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Single
Married
Divorced
Seperated
Common Law
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2005
2006
2007
2008
2009
2010
Other Photo ID Type
Other Photo ID #
Expiry date
Email
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2005
2006
2007
2008
2009
2010
Employment Information
Name
Address
City
Province
AB
BC
MB
NF
LB
NB
NT
NS
ON
PE
PQ
SK
YT
Employment Duration
Occupation/Job Title
Years
Months
Work Phone (xxx-xxx-xxxx)
Income per month (before taxes and other deductions)
$
Previous Employer (if less than 2 years ago)
Name
Address
City
Province
AB
BC
MB
NF
LB
NB
NT
NS
ON
PE
PQ
SK
YT
Employment Duration
Occupation/Job Title
Income per month (before deductions)
Years
Months
$
/Month
Co-Applicant Information
First Name
Last Name
Social Insurance Number
Birth Date
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Spouse's Employer
Employer's Address
Employer's City
Employer's Province
AB
BC
MB
NF
LB
NB
NT
NS
ON
PE
PQ
SK
YT
Employer's Phone (xxx-xxx-xxxx)
Length of Employment
Income per month (before deductions)
Years
Months
$
/Month
Landlord/Mortgage Holder Information (If Band Housing Select Band from Housing Type)
Land Type
Rent/Mortgage Payment
Landlord/Mortgage Holder Name
Landlord Address
Landlord Phone
Select
Rent
Own
Family
Band
Other
$
/Month
If you are a Homeowner
Mortgage When Opened
Mortgage Currently Owing
Market Value of Home
$
$
$
Previous Address ( if current address is less than 2 years)
Address
City
Province
Duration at Address
AB
BC
MB
NF
LB
NB
NT
NS
ON
PE
PQ
SK
YT
Years
Months
Trade-In Information
Year
Model
Mileage (kms)
I'm Looking For:
Available Down Payment
Desired Monthly Payment
$
$
Financial Information
Have you Declared Bankruptcy in the last 7 years?
If yes, Date Discharged
Have you ever had a repossession?
select
Yes
No
Select
Yes
No
Bank Name
Bank Address
Bank Phone
Account Type
Account Number
Balance
Select
Chequing
Savings
Additional Comments:
Acknowledgment and Consent
By signing below, you affirm that the information you have given in this Application is true and complete and that you have not withheld any information. We will rely on the information you have given us to decide on your Application. You authorize us to give to, obtain, verify, share and exchange credit and other information about you and with others, including credit bureaus, and other persons with whom you may have financial dealings as well as any other person as may be permitted or required by law. you also expressly waive your right, where permitted by law, to receive a copy of any Financial Statements or Financing Change Statements registered under the Personal Property Security Act as a result of a loan made by us to you or any renewal or discharge thereof.
C W AutoKing,
310 Transport Rd., Winnipeg, MB, R2C2Z2,
Phone:
(204) 777-5088,
Fax:
(204) 777-5087
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