YORKDALE DUFFERIN MAZDA
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 APPLICANT INFORMATION
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Please complete the form below with the most information as possible. Please also complete the Co-applicant Information section if you wish to present your spouse or other co-applicant in your credit request. Incomplete credit requests will be ignored.

*Fields marked with an asterisk are mandatory
ABOUT YOU
Salutation *First name *Last name
Mr. Ms.
Date of birth *Social Insurance Number Driver's licence number
*Home phone number Work phone number *Email address
( )-    ( ) -  ext. 

THE VEHICLE YOU'RE INTERESTED IN
Make Model and trim Year
Transmission Exterior color Number of doors
Automatic Manual
Maximum monthly payment Available down payment  
$/month Taxes included Taxes included  

YOUR PERSONAL INFORMATON
Marital status Number of dependents Monthly gross income
/Month
Have you declared bankruptcy?  If alimony, amount :
If yes, are you now free ?    Freed on : 

YOUR CURRENT ADDRESS
*Number *Street App., P.O. Box, R.R. or other
*City *Province *Postal code
*Residence type Owner or rent *How long have you been living there
If you are an owner If you are renting
Amount of mortgage Monthly rent
$ $/month
Mortgage montly payment Owner's name
$/month
Market value of your property Owner's phone number
$

YOUR PREVIOUS ADDRESS
Please complete this section if you've been living at your current address for less than a year.
Number Street App., P.O. Box, R.R. or other
City Province Country or Postal code
Residence type Owner or rent Length of occupation
Monthly rent or mortgage payment
$/month

YOUR CURRENT OCCUPATION
Occupation Profession Job type
Employer's name Employer's address
Employer's city and province Employer's phone number
Monthly gross income Job duration
$/month

YOUR PREVIOUS OCCUPATION
Please complete this section if you've been in your current occupation for under 2 years.
Occupation Profession Job type
Employer's name Employer's address
Employer's city and province Employer's phone number
Monthly gross income Job duration
$/month


CO-APPLICANT INFORMATION

YOUR CO-APPLICANT
Salutation First name Last name
Mr. Ms.
Date of birth Social Insurance Number Driver's licence number
Home phone number Work phone number Email address

CO-APPLICANT'S PERSONAL INFORMATION
Marital state Number of dependant people Monthly gross income
$/month
Have you declared bankruptcy? 
If yes, are you free ?    Freed on : 

CO-APPLICANT'S CURRENT ADDRESS
Same address as applicant.
Number Street App., P.O. Box, R.R. or other
City Province Postal code
Residence type Owner or rent Length of occupation
If you are an onwer If you are renting
Amount of mortgage Monthly rent
$ $/month
Mortgage monthly payment Owner's name
$/month
Market value of property Owner's phone number
$
  Owner's email address
 

CO-APPLICANT'S PREVIOUS ADDRESS
Please complete this form if your co-applicant lives at his current address for under a year.
Same address as applicant.
Number Street App., P.O. Box, R.R. or other
City Province Country or Postal code
Residence type Owner or rent Length of occupation
Monthly rent or mortgage payment
$/month

CO-APPLICANT'S CURRENT OCCUPATION
Occupation Profession Job type
Employer's name Employer's address
Employer's city and province Employer's phone number
Monthly gross income Job duration
$/month

CO-APPLICANT'S PREVIOUS OCCUPATION
Please complete this form if co-applicant has been in his/her current occupation for under a year.
Occupation Profession Job type
Employer's name Employer's address
Employer's city and province Employer's phone number
Monthly gross income Job duration
$/month


OTHER INFORMATION

QUESTIONS, COMMENTS OR OTHER RELEVANT INFORMATION
Please add any questions, comments and/or additional information that are relevant to your credit request:

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Yorkdale Dufferin Mazda
2451 Dufferin Street,
Toronto, ON M6B 3P6
info@yorkdaledufferinmazda.ca
Tel: 416 789 4521
Fax: 416 789 3113