Vehicle Financing Application Form

VEHICLE FINANCING APPLICATION FORM

DEALERSHIP:

TELEPHONE:

Make:

Model:

Year:

VIN#:

KM’S:

Trade Details

Purchase Price: ____________________

Life Ins: _________________________

Year: ___________________

Admin Fees: _______________________

Dis. Ins: _________________________

Make: ________________________

Cash Down: _______________________

Ext War: ________________________

Model: ________________________

Trade In: __________________________

Pro Pac: _________________________

Value: ________________________

Lien Payout: _______________________

GST: ____________________________

Payout made to:

Total Financing Request: ____________________

______________________________

Interest Rate: ____________Payment :__________________

Term/Amort:_________

A

S

F

M

DATE OF BIRTH

#

Married

Single

PPLICANT

URNAME

IRST NAME

IDDLE

SIN

Divorced

Separated

M

M

M

M

P

#

R

RS

ISS

S

HONE

P

How Long?

CITY

PROVINCE

POSTAL CODE

RESENT ADDRESS

)

How Long?

CITY

PROVINCE

POSTAL CODE

(

2

PREVIOUS ADDRESS

IF LESS THAN

YRS

E

H

?

#

N

D

S

E

(

/

)______

MPLOYER

OW LONG

PHONE

UMBER OF

EPENDENTS

ELF

MPLOYED

YES

NO

/

ADDRESS

ANNUAL INCOME

OCCUPATION

POSITION

.

&

H

L

?

#

PREV

OCCUPATION

EMPLOYER

(

2

)

OW

ONG

PHONE

IF LESS THEN

YEARS

C

-

S

F

M

D

#

R

O

APPLICANT

URNAME

IRST NAME

IDDLE

ATE OF BIRTH

SIN

ELATIONSHIP TO APPLICANT

H

L

?

CITY

PROVINCE

POSTAL CODE

HOME ADDRESS

OW

ONG

.

H

L

CITY

PROVINCE

POSTAL CODE

(

2

)

?

PREV

ADDRESS

OW

ONG

LESS THAN

YRS

/

#

OCCUPATION

POSITION

PHONE

H

L

?

ADDRESS

ANNUAL INCOME

(

/

) _______

EMPLOYER

OW

ONG

SELF EMPLOYED

YES

NO

.

H

L

#

2

?

PREV

EMPLOYER

OW

ONG

PHONE

IF LESS THAN

YRS

O

S

I

:

THER

OURCES OF

NCOME

Mortgage Company:

Value:

Present Balance:

MTG PMT/ RENT:

Landlord (renting):

PI

PIT

FINANCIAL INSTITUTION:

Accounts:

CHQ

SAV

OTHER ASSETS:

(

B

L

, F

C

, L

C

, C

C

,

)

CREDIT REFERENCES

INCLUDE

ANK

OANS

INANCE

OMPANIES

INE OF

REDIT

REDIT

ARDS

OTHER

Name

Address

Account #

Date Opened

Cr Limit

Mthly Pmt

Balance

Personal References 1)

Address

Phone#

2)

Address

Phone#

P

B

RIVACY IN

ANKING

1.

By signing below, you authorize BANK WEST (“we” or “us”) to collect your credit and other relevant personal information (a) from you on this form and from time to time

through other mechanisms, (b) from the auto dealership representative (the “Broker”), and (c) from credit bureaus, other credit granters, in each case as required for use for

the purposes of making a decision on your application for credit; protecting you and us against fraud and error; as permitted or required by law; to understand your needs; to

determine your eligibility for our products and services; and to help us match our products and services to your needs and for such other purposes for which you may provide

consent from time to time (the “Purposes”).

2.

By signing below, you also authorize us, from time to time, to (a) disclose relevant personal information to the Broker, in order that the Broker may provide you with

information in connection with the Purposes; (b) disclose your credit and other relevant personal information to credit bureaus and other credit granters as required for the

purposes of such parties making a decision on your applications for credit after the removal of your personal identifiers, creating market analyses and other statistical studies;

(c) disclose your personal information to third party service providers for the purposes of debt collection and the registration of liens and other security interests relating to

credit provided to you, for dispute resolution purposes; and (d) disclose your personal information as required or permitted by law.

3.

If you have any questions about the personal information we have on our file on you, contact Bank West toll free at 1- 888 -440 -2265.

By signing below, you certify that the information in this application is true and correct and that you authorize us to rely on such personal information.

Bank West will contact the car dealership representative with its approval or decline with respect to a loan request made.

________________________________________

___________________

___________________________________

’

-

’

S

DATE

APPLICANT

S SIGNATURE

CO

APPLICANT

S

IGNATURE