Applicants Information
* Applicants Name: * Social Insurance Number * Birth Date * Marital Status:
S   -   M   -   CL   -   D
* Address: * City * Postal Code   How Long: Payments:
* # of Dependants: Home Phone: Work Phone * Cell Phone: * Email:
Previous Address (If less than 2 yrs at current) How Long: 2nd Previous Address (If less than 2 yrs at current) How Long:
Fields with (*) are obligatory
Applicant's Employment Information
Applicants Current Employer: Employer Contact Name & Number: Self Employed:
How Long: Position: Income: Additional Income & Source:
Applicants Previous Employer (If less than 2 yrs at current): Position Income: How Long:
 
Applicants 2nd Previous Employer (If less than 2 yrs at 1st previos): Position: Income: How Long:
 
Co-Applicant Relationship to Applicant
Applicants Name: Social Insurance Number Birth Date Marital Status:
S   -   M   -   CL   -   D
Address: City Postal Code   How Long: Payments:
# of Dependants: Home Phone: Work Phone Cell Phone: Email:
Previous Address (If less than 2 yrs at current) How Long: 2nd Previous Address (If less than 2 yrs at current) How Long:
 
Co-Applicant's relationship Employment Information
Applicants Current Employer: Employer Contact Name & Number: Self Employed
How Long: Position: Income: Additional Income & Source:
Applicants Previous Employer (If less than 2 yrs at current): Position Income: How Long:
 
Applicants 2nd Previous Employer (If less than 2 yrs at 1st previos): Position: Income: How Long:
 
Additional Information
Desired Purchase Year: Desired Purchase Make: Desired Purchase Model: Finance Amount:
Referral Source / Sales Rep: Where did you hear about us?:
Comments / feedback:
Trade in Vehicle
Year: Make: Model: Current KM / Hours:
Confirm

I hereby certify that the information given above is true, accurate and complete as at the statement date. I fully understand that such information shall be used to determine my cedit worthiness. I understand that ALL INFORMATION WILL BE VERIFIED and any information that proves inaccurate may result in the application being terminated. I authorize LionAutos Enterprise to obtain all the information it requires. I also authorize LionAutos Enterprise. to disclose from time to time to other lenders credit bureaus and other reporting agency any credit information about me.

Dated: Signed:
Dated: Signed:


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