Credit Application

Personal Information

Salutation Salutationis

First Name required First Nameis required

Middle Name required Middle Nameis required

Last Name required Last Nameis required

Date Of Birth required Date Of Birthis required

Marital Status required Marital Statusis required

Social Insurance Social Insuranceis

Gender required Genderis required

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

Expiry Date Expiry Dateis

How should we reach you?

Preferred Method of Contact?

Phone Text Email Any

Phone Number required Phone Numberis required

Mobile Phone Number Mobile Phone Numberis

Work Phone Number Work Phone Numberis

E-Mail Address E-Mail Addressis

Current Home Address

Address Type required Address Typeis required

Street/RR# required Street/RR#is required

Street or Station Name required

Street Type required Street Typeis required

Street Direction Street Directionis

Apt/Unit# Apt/Unit#is

Province required Provinceis required

City/Townrequired City/Townis required

Postal Code required Postal Codeis required

Years at Address required Years at Address is required

Months at Address required Months at Addressis required

Housing Information

Residential Status required Residential Statusis 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 Nameis

Landlord Phone No. Landlord Phone No.is

Previous Home Address

Previous Address Type Previous Address Typeis

Previous Street/RR# Previous Street/RR#is

Previous Street or Station Name Previous Street or Station Nameis

Previous Street Type Previous Street Typeis

Previous Street Direction Previous Street Directionis

Previous Apt/Unit# Previous Apt/Unit#is

Province

City/Town City/Townis

Previous Postal Code Previous Postal Codeis

Years at Previous Address Years at Previous Addressis

Months at Previous Address Months at Previous Addressis

Current Employment Information

Employment Status required Employment Statusis required

Employment Type Employment Typeis

Current Employer required Current Employeris required

Years Employed required Years Employedis required

Months Employed required Months Employedis required

Occupation required Occupationis required

Work Contact Phone required Work Contact Phoneis required

Work Contact Ext. Work Contact Ext.is

Address Type Address Typeis

Street/RR# required Street/RR#is required

Street or Station Name required Street or Station Nameis required

Street Type required Street Typeis required

Street Direction Street Directionis

Employer Unit# Employer Unit#is

Province required

City/Town required City/Townrequired

Postal Code required Postal Codeis 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 Statusis

Previous Emp Type Previous Emp Typeis

Previous Employer Previous Employeris

Years Employed required Years Employedis required

Months Employed required Months Employedis required

Previous Occupation required Previous Occupationis required

Previous Work Contact Phone required Previous Work Contact Phoneis required

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

Address Type required Address Typeis required

Street/RR# required Street/RR#is required

Street or Station Name required Street or Station Nameis required

Street Type Street Typeis

Street Direction Street Directionis

Employer Unit# Employer Unit#is

Province required

City/Town required City/Townis required

Postal Code required Postal Codeis required

Financing Information

Financed Amount Financed AmountMust be numeric

Term Termis

Cash Down Cash DownMust be numeric

Monthly Payment Monthly PaymentMust be numeric

Tell us about your Vehicle

Make Makeis

Model Modelis

Trim Trimis

Year Yearis

Kilometers KilometersMust be numeric

VIN VINis

Colour Colouris

Condition Conditionis

Desired Purchase

Asset Type Asset Typeis

Asset Classification Asset Classificationis

Condition Conditionis

Year Yearis

Make Makeis

Model Modelis

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 Makeis

Model Modelis

Trim Trimis

Colour Colouris

Year (Min) Year (Min)is

Year (Max) Year (Max)is

Price (Min) Price (Min)is

Price (Max) Price (Max)is

Payment Amount Payment Amountis

Payment Frequency Payment Frequencyis

Down Payment Down PaymentMust be numeric

Request Another Vehicle

Service Request

Make Makeis

Model Modelis

Year Yearis

Kilometers Kilometers Must be numeric

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

Service Notes Service Notesis

Service Date Requested Service Date Requestedis

Service Time Earliest Service Time Earliestis

Service Time Latest Service Time Latestis

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 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.

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.