Credit Application

Personal Information
Salutationis
First Nameis required
Middle Nameis required
Last Nameis required
Date Of Birthis required
Marital Statusis required
Social Insuranceis
Genderis required
Driver's Licence No.is
Expiry Dateis
How should we reach you?
Preferred Method of Contact?

Phone Numberis required
Mobile Phone Numberis
Work Phone Numberis
E-Mail Addressis
Current Home Address
Address Typeis required
Street/RR#is required
Street Typeis required
Street Directionis
Apt/Unit#is
Provinceis required
City/Townis required
Postal Codeis required
Years at Address is required
Months at Addressis required
Housing Information
Residential Statusis required
$
Market Value (if owned)Must be numeric
$
Mortgage BalanceMust be numeric
$
Monthly Rent/Mort.requiredMust be numeric
Mortgage Co. OR Landlord Nameis
Landlord Phone No.is
Previous Home Address
Previous Address Typeis
Previous Street/RR#is
Previous Street or Station Nameis
Previous Street Typeis
Previous Street Directionis
Previous Apt/Unit#is
City/Townis
Previous Postal Codeis
Years at Previous Addressis
Months at Previous Addressis
Current Employment Information
Employment Statusis required
Employment Typeis
Current Employeris required
Years Employedis required
Months Employedis required
Occupationis required
Work Contact Phoneis required
Work Contact Ext.is
Address Typeis
Street/RR#is required
Street or Station Nameis required
Street Typeis required
Street Directionis
Employer Unit#is
Postal Codeis required
Current Income Information
$
Income Amountrequired Must be numeric
Income Frequency is required
$
Other Income Amount Must be numeric
Other Income Frequency is
Other Income Type is
Other Income Description is
Previous Employment Information
Previous Emp Statusis
Previous Emp Typeis
Previous Employeris
Years Employedis required
Months Employedis required
Previous Occupationis required
Previous Work Contact Phoneis required
Previous Work Contact Ext.is required
Address Typeis required
Street/RR#is required
Street or Station Nameis required
Street Typeis
Street Directionis
Employer Unit#is
City/Townis required
Postal Codeis required
Financing Information
$
Financed AmountMust be numeric
Termis
$
Cash DownMust be numeric
$
Monthly PaymentMust be numeric
Tell us about your Vehicle
I have a vehicle to Trade-In 
Makeis
Modelis
Trimis
Yearis
KilometersMust be numeric
VINis
Colouris
Conditionis

Add A Model

×
Desired Purchase
Asset Typeis
Asset Classificationis
Conditionis
Yearis
Makeis
Modelis
VIN / HIN / Serial No
Stock Number
$
OfferMust be numeric
Item Request
What type of vehicle are you looking for?
Makeis
Modelis
Trimis
Colouris
Year (Min)is
Year (Max)is
Price (Min)is
Price (Max)is
Payment Amountis
Payment Frequencyis
$
Down PaymentMust be numeric
Request Another Vehicle
Service Request
Makeis
Modelis
Yearis
Kilometers Must be numeric
                   
Service Notesis
Service Date Requestedis
Service Time Earliestis
Service Time Latestis
How did you hear about us?
Please let us know how you heard about us.
Please take a moment to tell us how you heard about us.
Referral Source (Other)is
Customer Comments
Customer Commentsis
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.


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.