Financing - Le Spécialiste du VTT

*Mandatory fields

I plan to buy
(or lease) a vehicle in:

PERSONAL INFORMATION

*Name:

Date of birth (year/month/day):

Social Insurance Number:

*Driver's licence number:

*E-mail:

Phone (with area code):

Fax (with area code):

Address:

City:

Province:

Postal Code:

At this address since:

OWNER (if applicable)

Mortgage Institution:

Phone (with area code):

Account number:

TENANT (if applicable)

Name of landlord:

Phone (with area code):

Monthly Rent $:

OTHER (if applicable)

Specify:

Balance $:

House Value $:

PRESENT EMPLOYER

Company or Owner:

How long (years, months):

Position:

Phone at work:

Income $:

PREVIOUS EMPLOYER

Company or Owner:

How long (years,months):

Position:

Phone at work:

2ND PREVIOUS EMPLOYER

Company or Owner:

How long (years,months):

Position:

Phone at work:

OTHER SOURCE OF INCOME

Specify:

Amount $:

ASSETS, OTHER THAN ABOVE (EX: RRSPs, INVESTMENTS, ETC.)

Specify:

Nature:

Value $:

INFORMATION ON THE CAR TO BE FINANCED

Desired vehicle:

Make:
Model:
Year:

Trade-in vehicle:

Make:
Model:
Year:
Milleage:
Value:
Balance:

Cash down payment:

Monthly budget:

/month

BANK ACCOUNT INFORMATION

Bank Name:

Address:

Phone (with area code):

Have you ever been bankrupt?

No Yes

Do you have a credit card?

No Yes

If yes, specify the type:

Visa Mastercard Amex Other

If yes, specify the number:

OTHER BANK ACCOUNT INFORMATION

Bank Name:

Address:

Phone (with area code):

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YES! I want to receive information on future contests, surveys, special promotions and new content from "Le Spécialiste du VTT".