Finance Application - Amerikal Auto

Personal Information

Applicants Name*

First Middle Last

Date of Birth*

Phone #*

SIN*

Marital Status*

# of Dependents*

Address*

Street Address City Postal Code

Are you aboriginal status?*

Yes

No

Treaty #*

Did someone refer you to us?*

Yes

No

Name of the person who referred you

Do you rent or own?*

Rent

Own

Mortgage Info

Mortgage Balance*

How much is left to be paid on your property.

Monthly Mortgage Payments*

Rent Info

Monthly Rent*

Landlord's Name

Employment Information

Your monthly income (before tax)*

Employer*

Place name where you work

Employer's Phone #

Your Job Title*

Employers Address*

Street Address City

How long you have worked at this place?

Year(s)*

Month(s)*

Previous Employer

Place name where you work before your current job

Previous Employers Phone #

Previous Job Title

Previous Employers Address*

Street Address City

Financial Information

Have you claimed bankruptcy in the last 7 years?*

Yes

No

Are you currently past due on any payments?*

Yes

No

Do you currently have any open collection items?*

Yes

No

Credit cards balance

Please include combined total of all of your cards

Line of credits balance

Please include combined total of all of your account

Do you have other loans?

No

Yes

Please write down type of loan and it's balance*

Please write down value and name of any other assets you might have

Assets are any real estate property, vehicles, RRSP's etc

My signature below indicates that all of the information I have provided is, to the best of my knowledge, truthful. I herby authorize EPIC Dealer Solutions Ltd. and its credit lenders to obtain, exchange, and release my credit reports, personal information, and make any necessary inquires regarding our loan application for the purpose of interested lenders providing funds on our behalf for our conditional vehicle purchase. I authorize those lending institutions that approve this loan application and are willing to provide funds on our behalf to forward a copy of the loan agreement, and all other relevant documents, to EPIC Dealer Solutions Ltd. or to the automobile dealership listed on our application.

Signature*

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Phone

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AMERIKAL AUTO FINANCING APPLICATION