Credit Application

Personal Information

Salutation Salutation is

First Name required First Name is required

Middle Name required Middle Name is required

Last Name required Last Name is required

Date Of Birth required Date Of Birth is required

Marital Status required Marital Status is required

Social Insurance Social Insurance is

Gender required Gender is required

Driver's Licence No. Driver's Licence No. is

Expiry Date Expiry Date is

How should we reach you?

Preferred Method of Contact?

Phone Text Email Any

Phone Number required Phone Number is required

Mobile Phone Number Mobile Phone Number is

Work Phone Number Work Phone Number is

E-Mail Address E-Mail Address is

Current Home Address

Address Type required Address Type is required

Street/RR# required Street/RR# is required

Street or Station Name required

Street Type required Street Type is required

Street Direction Street Direction is

Apt/Unit# Apt/Unit# is

Province required Province is required

City/Townrequired City/Town is required

Postal Code required Postal Code is required

Years at Address required Years at Address is required

Months at Address required Months at Address is required

Housing Information

Residential Status required Residential Status is required

Market Value (if owned) Market Value (if owned)Must be numeric

Mortgage Balance Mortgage BalanceMust be numeric

Monthly Rent/Mort. required Monthly Rent/Mort.requiredMust be numeric

Mortgage Co. OR Landlord Name Mortgage Co. OR Landlord Name is

Landlord Phone No. Landlord Phone No. is

Previous Home Address

Previous Address Type Previous Address Type is

Previous Street/RR# Previous Street/RR# is

Previous Street or Station Name Previous Street or Station Name is

Previous Street Type Previous Street Type is

Previous Street Direction Previous Street Direction is

Previous Apt/Unit# Previous Apt/Unit# is

Province

City/Town City/Town is

Previous Postal Code Previous Postal Code is

Years at Previous Address Years at Previous Address is

Months at Previous Address Months at Previous Address is

Current Employment Information

Employment Status required Employment Status is required

Employment Type Employment Type is

Current Employer required Current Employer is required

Years Employed required Years Employed is required

Months Employed required Months Employed is required

Occupation required Occupation is required

Work Contact Phone required Work Contact Phone is required

Work Contact Ext. Work Contact Ext. is

Address Type Address Type is

Street/RR# required Street/RR# is required

Street or Station Name required Street or Station Name is required

Street Type required Street Type is required

Street Direction Street Direction is

Employer Unit# Employer Unit# is

Province required

City/Town required City/Townrequired

Postal Code required Postal Code is required

Current Income Information

Income Amount required Income Amountrequired Must be numeric

Income Frequency required Income Frequency is required

Other Income Amount Other Income Amount Must be numeric

Other Income Frequency Other Income Frequency is

Other Income Type Other Income Type is

Other Income Description Other Income Description is

Previous Employment Information

Previous Emp Status Previous Emp Status is

Previous Emp Type Previous Emp Type is

Previous Employer Previous Employer is

Years Employed required Years Employed is required

Months Employed required Months Employed is required

Previous Occupation required Previous Occupation is required

Previous Work Contact Phone required Previous Work Contact Phone is required

Previous Work Contact Ext. required Previous Work Contact Ext. is required

Address Type required Address Type is required

Street/RR# required Street/RR# is required

Street or Station Name required Street or Station Name is required

Street Type Street Type is

Street Direction Street Direction is

Employer Unit# Employer Unit# is

Province required

City/Town required City/Town is required

Postal Code required Postal Code is required

Financing Information

Financed Amount Financed AmountMust be numeric

Term Term is

Cash Down Cash DownMust be numeric

Monthly Payment Monthly PaymentMust be numeric

Tell us about your Vehicle

Make Make is

Model Model is

Trim Trim is

Year Year is

Kilometers KilometersMust be numeric

VIN VIN is

Colour Colour is

Condition Condition is

Desired Purchase

Asset Type Asset Type is

Asset Classification Asset Classification is

Condition Condition is

Year Year is

Make Make is

Model Model is

VIN / HIN / Serial No VIN / HIN / Serial No

Stock Number Stock Number

Offer OfferMust be numeric

Item Request

What type of vehicle are you looking for?

Make Make is

Model Model is

Trim Trim is

Colour Colour is

Year (Min) Year (Min) is

Year (Max) Year (Max) is

Price (Min) Price (Min) is

Price (Max) Price (Max) is

Payment Amount Payment Amount is

Payment Frequency Payment Frequency is

Down Payment Down PaymentMust be numeric

Request Another Vehicle

Service Request

Make Make is

Model Model is

Year Year is

Kilometers Kilometers Must be numeric

Please Select Service Items Required: Oil Change Winter Tires Scheduled Service Diagnose & Repair Detailing

Service Notes Service Notes is

Service Date Requested Service Date Requested is

Service Time Earliest Service Time Earliest is

Service Time Latest Service Time Latest is

How did you hear about us?

Please let us know how you heard about us.

Referral Source Please take a moment to tell us how you heard about us.

Referral Source (Other) Referral Source (Other) is

Customer Comments

Customer Comments is

Disclosure & Privacy Notice

By checking the box below, I consent to the collection, use and disclosure of my personal information as described in this paragraph. I agree that the personal information provided above may be used and disclosed by Grafton Automotive Inc. and/or its agents or service providers (collectively, the "Dealer") as necessary to obtain credit, financial and related personal information (including a credit or consumer information report) about me from any credit bureau or credit reporting agency, and to advise me on credit availability in connection with product and/or service purchase financing. I further agree that the personal information provided above may be disclosed to the provider of Grafton Automotive Inc.'s website hosting or related services for the purpose of enabling Dealer to access my personal information for marketing purposes. Personal information I provide and credit information obtained may also be retained by Dealer and used to facilitate the application process should I subsequently choose to apply for credit through Dealer.

Please Confirm:

I have read and agree to the Terms & Conditions above.

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Grafton Automotive Inc. is committed to respecting the privacy of individuals and recognizes a need for the appropriate management and protection of any personal information that you agree to provide us. We will not share your information with any third party outside of our organization, other than as necessary to fulfill your request.