Credit Application

 

Fax:  604-856-2397

Date:

 

 

 

 

PERSONAL  INFORMATION

Applicant’s Name  (first name, initial, and last name)

Mr.         Ms.

Mrs.       Miss.

Birth Date

MM

|

DD

|

YY

|

Number of Dependants

 

 

Applicant’s Social Insurance Number  (optional)

Applicant’s Driver’s License Number  /  Province

Spouse’s Name  (include first name and initial)

 

 

Spouse’s Social Insurance Number  (optional)

Spouse’s Birth Date

MM

|

DD

|

YY

|

ADDRESS  INFORMATION

Present Address  (Street Number and Name)

 

City

Province

 

 

Postal Code

How Long?

Years

 

Months

 

Home Telephone Number  (include area code)

E-mail

 

Rent

 

Own

 

Room &

Board

Rent/Mortgage Amount

$

Landlord’s Name and Telephone Number/Mortgage Holder

Former Address  (Street Number and Name) if less than 2 years at present

 

 

City

Province

EMPLOYMENT  INFORMATION

Present Employer Name

 

 

Address

Business Telephone Number

 

 

Nature of Business

How Long?

Years

 

Months

 

Occupation

Gross Monthly Income

$

Former Employer Name  (if less than 2 years at present)

 

 

Address

How Long?

Years

 

Months

 

Occupation

Spouse Employer Name

 

 

Address

Business Telephone Number

How Long?

Years

 

Months

 

Occupation

Gross Monthly Income

$

Source of Other Income

Other Monthly Income

$

BANK  ACCOUNT  INFORMATION

1

Financial Institution Name

Address

Account Number

Balance

 

$

T

Y

 

Chequing

 

Savings

 

Other

2

 

 

 

 

 

$

P

E

 

Chequing

 

Savings

 

Other

ASSET  AND  CREDITOR  INFORMATION

Asset Description

(eg. property, vehicles, investments)

 

Value

 

$

Creditor Name & Address

Monthly Payment

 

$

Balance

 

$

 

 

$

 

 

$

 

$

 

 

$

 

 

$

 

$

 

 

$

 

 

$

 

$

Have you ever been bankrupt?

 

Yes

 

No

Have you ever had a repossession?

 

Yes

 

No

PERSONAL  REFERENCES

1

Relationship

 

Name, Address and Telephone Number

Employer

2

 

 

 

 

KKRVC

 

Each of the undersigned:  hereby authorize Kustom Koach RV Centre to investigate my credit record and to establish and maintain a file of personal information about me.  I affirm that all information given above is true and complete.  I consent to Kustom Koach RV Centre obtaining consumer reports and other credit information from, and disclosing consumer reports and other credit information to, credit reporting agencies, the credit bureau, any person or corporation with whom or which I have had financial relations and suppliers of services such as collection agencies or bailiffs and persons which Kustom Koach RV Centre may have business dealings with specifically related to the servicing and financing of my account. I consent to this collection, use and disclosure of consumer reports and other credit information for the purposes of: assessing my creditworthiness in connection with financing transactions, making a decision about my credit application; monitoring, evaluating, servicing and collecting my account; and responding to inquiries about my application, account or file.

 

 

Date

 

 

Applicant’s Signature

 

 

Co-applicant’s Signature