Dealership Information
Prime Autos
Contact Name
Phone Number
( )
Personal Information
Title
First Name
Middle Name
Last Name
Martial Status
Date of Birth
Cell Phone Number
( )
Email
SIN #
- -
Driver's License Number
Learner's License
Current Residence
Address Type
Apartment Number
House No./Box No.
Street Name
City
Province
Postal Code
Home Phone Number
( )
Years at Address
Months at Address
Previous Residence
Address Type
Apartment Number
House No./Box No.
Street Name
City
Province
Postal Code
Home Phone Number
( )
Years at Address
Months at Address
Current Employment
Employment Status
Occupation / Job Title
Employer Name
Employer Phone Number
( )
Employer Address
Employer City
Employer Province
Years with Employer
Months with Employer
Previous Employment
Employment Status
Occupation / Job Title
Employer Name
Employer Phone Number
( )
Employer Address
Employer City
Employer Province
Years with Employer
Months with Employer
Finance Summary
Gross Monthly Salary
Other Monthly Income
Other Monthly Income Description
Total Monthly Income
Current Home Status
Mortgage Holder's Name
Monthly Rent / Mortgage Payment
Home's Market Value
Mortgage Balance
Credit Card Type
Credit Card Number
Other Monthly Obligations
Other Monthly Obligations Description
Banking
Bank Name
Years At Bank
Additional Deal Information
Monthly Payment Range
From $
Up to $
Down Payment
From $
Up to $
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Vehicle & Deal Notes
Include: Vehicle Information (make, model, trim, kms) and any additional information important to the deal.

I/We certify all the information in this application is true and accurate to the best of my knowledge. I/We acknowledge all the personal information gathered may be used to assess my credit worthiness, provide products, and administer the contract and to perform services as may be requested. I/We further authorise Finance West, in the course of processing this application, to disclose information as required to third parties including, but not limited to, credit reporting agencies, financial institutions, financing companies, securitization organizations and insurance companies. This permission to disclose my personal information includes when required or permitted to do so by law. Subject to legal and contractual requirements, you may refuse or withdraw your consent to certain of the identified purposes at any time by contacting Finance West Inc.

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