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Credit Application

APPLICANT'S PERSONAL INFORMATION

Last name	First name	Middle Initial
Address		Postal Code
City	Province	Own Rent Other
Phone	Cell	Own Rent Other
How long at address	No. of dependant(s)
Landlord / Mortage Holder Name	Landlord / Mortage Holder Phone
Date of Birth (mm/dd/yy)	Social Insurance Number	Drivers License No
Previous Address (if < 1 yrs at present)		How long at address

EMPLOYMENT

Present Employer

Nature of Business

Address

Phone

Gross Monthly Income

How long with present employer

Current Position

Other Income

Former Employer

Phone

Occupation

How long with previous employer

SPOUSE / CO-APPLICANT

Last name

First name

Middle initial(s)

Date of birth (mm/dd/yy)

Social Insurance Number

Present Employer

Phone

Gross Monthly Income

How long with present employer

Current Position

PERSONAL STATEMENT

Assets	Value
Real Estate
Autos
Cash
Other
Other
Total

Liabilities	Amount Owing	Monthly Payment
Mortgage Holder & Phone No.
Rent
Credit Cards
Loans
Other
Real Estate
Total

Name of Bank	Phone	Contact
Address/Branch No		Account No.
Credit Cards VisaAmexMastercardOther

RELATIVES, CLOSE FRIENDS OR ASSOCIATES

(required)

Name	Address	Phone
Name	Address	Phone
Name	Address	Phone

LEASE REQUEST

Year	Make	Model
NewUsed	KM's or Length	ID Number or Serial Number
Purchase Price	Down Payment	Monthly Payment Target
Preferred Term	LeaseFinance

The undersigned certifies the above information to be true and correct. By signing below, I consent to Dominion For Finance Inc. (herein referred to as Dominion) and its subsidiaries and affiliates obtaining from any credit reporting agency or credit grantor, such information as it may require at any time in connection with the credit hereby applied for, and consent to the disclosure at any time of any information concerning the undersigned to any credit reporting agency or to any credit grantor with whom the undersigned has financial relations.

Dominion and its subsidiaries and affiliates may use my personal information (including credit and other financially-related information) and disclose it to each other when it is necessary in order to serve a customer, to meet legal and regulatory requirements, and for internal audit, statistical and record keeping purposes. Dominion may collect and use my personal information with subsidiaries and affiliates in order to identify and inform me of products and services that they offer.

Although not required by law, Dominion and its subsidiaries and affiliates may collect, use and share my SIN to help ensure accuracy on credit checks and for statistical and record-keeping purposes.

Please type Applicants full name here