Vehicle Owner Application SECTION 1 First Name: Middle: Last Name: Address City & Province: Postal Code: Are you over 19? —Please choose an option—YesNo Is the vehicle free and clear of all financial obligations? —Please choose an option—YesNo No:why? Are you the sole owner of the vehicle? —Please choose an option—YesNo No:name of other? How much cash do you require? $ How long do you require the loan for? 1 Year2 Year3 Year4 Year SECTION 2 Insurance Registration No: Plate: VIN: Make: Model: Trim: Year: Color: Odometer: Transmission: —Please choose an option—AutoManual Do You Have A Spare Key: YesNo Any damage in excess of $2,000.00, or has a rebuilt Engine? —Please choose an option—YesNo Yes:what? Is there collision insurance coverage on the vehicle? —Please choose an option—YesNo How much is the collision deductible? $ Insurance Expiry Date: SECTION 3 Driver's License Number: Province: Expiry Date: Date of Birth: SIN: Eye Color: Home Phone: Email: Please leave this field empty. Hair Color: Cell: Work Phone: Height: Employer: Marital Status: Weight: Job Title: Address: Spouse/Partner's Name: Address if different from yours: Phone: SECTION 4 Relatives Information: Name: Phone: Name: Phone: Friends Information: Name: Phone: Name: Phone: Preferred Monthly Payment Method —Please choose an option—Automatic WithdrawalDirect Bank DepositEmail Transfer Verify If You Are Human 2+3=? I agree to the terms & conditions.
