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204-990-5659
3370 Wilkes Ave, Winnipeg, MB R3S 1A8
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HOME
Inventory
View Inventory
Sell a car
Finance
Service
Detail
Roadside Assistance
About us
Our Team
Contact Us
AMERIKAL AUTO
FINANCING APPLICATION
1
Personal Information
2
Employment Information
3
Financial Information
Personal Information
Applicants Name
*
First
Middle
Last
Date of Birth
*
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Phone #
*
SIN
*
Marital Status
*
Single
Married
Common Law
Separated
Divorced
Widowed
# of Dependents
*
0
1
2
3
4
5
Address
*
Street Address
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
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
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
How long you have worked at this place?
Year(s)
*
Select
0
1
2
3
4
5+
Month(s)
*
0
1
2
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12
Previous Employer
Previous Employer
Place name where you work before your current job
Previous Employers Phone #
Previous Job Title
Previous Employers Address
*
Street Address
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
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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