Vehicle Owner Application SECTION 1First 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—YesNoNo:why? Are you the sole owner of the vehicle?—Please choose an option—YesNoNo:name of other? How much cash do you require?$ How long do you require the loan for?1 Year2 Year3 Year4 Year SECTION 2Insurance Registration No: Plate: VIN: Make: Model: Trim: Year: Color: Odometer: Transmission: —Please choose an option—AutoManualDo You Have A Spare Key: YesNo Any damage in excess of $2,000.00, or has a rebuilt Engine?—Please choose an option—YesNoYes:what? Is there collision insurance coverage on the vehicle?—Please choose an option—YesNo How much is the collision deductible?$ Insurance Expiry Date: SECTION 3Driver'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 4Relatives 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 Human2+3=? I agree to the terms & conditions.
