Are you trading in a vehicle? YesNo Vehicle Year/Make: Total Downpayment: $ Applicants Information First Name Middle Initial Last Name Social Insurance Number Date Of Birth (mm/dd/yyyy) Home Phone Number Street Address City Province Zip / Postal Code How long have you lived here? Years Months I rent this property I own this property Monthly Payment Number Of Dependants Marital Status SingleMarriedCommon-LawDivorced Valid Driver's License? YesNo Driver's License Number Expiry Date Current Landlord / Mortgage Information Previous Address Information Landlord or Mortgage Holder Landlord Phone Number Previous Landlord's Name Previous Landlord's Phone Number Previous Street Address Previous City How long did you live there? Years Months I rented this property I owned this property Monthly Payment If Mortgage Holder, how much is owing on house? Market Value of Home Employment Information Current Employer Employed How Long? Position Gross Monthly Income $ Full Time  Seasonal Part Time  Contract Guarenteed Hours Weekly? Contact Person (To Confirm Employment) Employer's Phone Number Previous Employer's Name How Long Employed Here? Position Contact Person Contact Phone Number Gross Monthly Income Other Source Of Income Second Previous Employment Spouse / Cosigner Information (If no Cosigner, leave blank) Working Spouse / Cosigner First & Last Name Spouse/Cosigner S.I.N. Cosigner's Address City Province Spouse/Cosigner Employer How Long Employed? Position Contact Person Phone Number Gross Monthly Income Bank and Reference Information (Personal References - Known more than 1 Year) Name Of Bank Address (Branch Name) Account Number Type Of Account ChequingSavings Credit Card Name Balance Owing Credit Card Name Balance Owing Have you ever been Bankrupt? YesNo If yes, Trustee Name Date of Discharge Family Reference Relationship How Long? Work Phone Home Phone Personal Reference Relationship How Long? Work Phone Home Phone Personal Reference Relationship How Long? Work Phone Home Phone Personal Reference Relationship How Long? Work Phone Home Phone I hereby certify that the information given above is true, accurate and complete as at the statement date. I fully understand that such information shall be used to determine my credit worthiness. I understand that ALL INFORMATION WILL BE VERIFIED and any information that proves inaccurate will result in the application being terminated and the deposit accompanying the application may be retained by the dealer. I authorize Prime Motors of London to obtain all the information it requires. Date: Today's Date Signed: Where should we call you: If your loan application is approved or should we have any additional questions, we will contact you at your home or business. Home PhoneWork Phone By clicking the Apply Now below, I certify that the above information is complete and accurate, and I authorize an investigation of my credit history and the release of information about my credit experience.