Carsons Credit Application

If you wish to have our credit department prior approve your new purchase, please fill out the form below and one of our Salesman will be back in touch with you to discuss your individual situation.

Vehicle Information

Vehicle Description:

Price:

Buyer Information

Title:	Mr. Mrs. Ms.
First Name:
Middle Name:
Last Name:
Marital Status:	Married Single Separated Divorced

S.I.N:
Drivers License
Date of Birth:

Apt. #:
Address:
City:
Province:
Postal Code:
Duration:	(Number of years residing at this address)

Email:
Home Telephone:
Business Telephone:

Employer's Name:
Employer's Address:
Employer's City:
Employer's Province:
Employer's Postal Code:
Years Employed:

If you have been at your present employment for less than 3 years, or if your are self employed, please complete the following section.

Gross Monthly Income:	(Before deductions)
Occupation:
Description of Other Income:

Co-Buyer's (Spouse's Information)

Title:	Mr. Mrs. Ms.
First Name:
Middle Name:
Last Name:
Marital Status:	Married Single Separated Divorced

S.I.N:
Date of Birth:

Address:
City:
Province:
Postal Code:
Duration:	(Number of years residing at this address)

Home Telephone:
Business Telephone:

Employer's Name:
Employer's Address:
Employer's City:
Employer's Province:
Employer's Postal Code:
Years Employed:

If you have been at your present employment for less than 3 years, or if your are self employed, please complete the following section.

Gross Monthly Income:	(Before deductions)
Occupation:
Description of Other Income:

Asset & Liability Information

Housing:	Rent Own Board Live with parents
Value of House:	(Approximate)
Name of Mortgage Holder or Landlord:

Balance Owing:
Monthly Payment:	(Include taxes)

Other Asset / Credit #1
(i.e. M/C, Visa, Vehicles etc.)

Specify:
Value / Limit:	(Approximate)
Name of Loan or Mortgage Holder:

Balance Owing:
Monthly Payment:	(Include taxes)

Other Asset / Credit #2
(i.e. M/C, Visa, Vehicles etc.)

Specify:
Value / Limit:	(Approximate)
Name of Loan or Mortgage Holder:

Balance Owing:
Monthly Payment:	(Include taxes)

Other Information

Have your declared bankruptcy in the last 7 years?:	Yes No
Have you had a vehicle repossessed?:	Yes No

Choose a Financial Company:

Pre-Authorized Payment

If my loan is approved, I authorize the Financial Institution (or its agent) to debit (charge) my regular loan payments to my account. I have read and agree to the additional terms documented below and I will provide the Financial Institution (or its agent) with my account information and my personal cheque marked VOID.

PRE-AUTHORIZED PAYMENT PROGRAM TERMS

If the account identified on the front of this form (the "Account') is a joint account which requires more then one.signature to authorize cheques and other debits, then all account holders must sign on the front.

I authorize the Financial Institution (or its agent) to debit to the Account all of my regular loan payments. This Authorization.is the same as if I had written a cheque for each loan payment; it also applies to different payments, if the Financial Institution and I agree in writing to change my loan payments, at any time. I may cancel this Authorization at any time by giving the Financial Institution (or its agent) prior written notice; this notice must be mailed in sufficient time so that the Financial Institution will receive it at least 10 days before a payment date. The address will be provided in correspondence which I will receive from the Financial Institution.

The financial institution at which my Account is located ("My Account F/I") has no duty to determine whether payments which it debits to my Account comply with this Authorization. I may require My Account F/I to return any payment to my Account by giving My Account F/I a signed and sworn Declaration within 90 days after the payment is debited (charged) to my Account. However, I may provide this Declaration only if: (a) the payment did not comply with this Authorization; (b) I revoked this Authorization on 10 days prior notice; OR (c) the payment was posted to the wrong account because the Financial Institution (or its agent) gave the wrong information to My Account F/I

My loan obligations will not be cancelled or reduced in any way if I revoke this Authorization or ask My Account F/I to return any payment(s) to my Account.

If my address or Account information changes. I must notify the Financial Institution (or its agent) promptly in writing.

Agreement

By pressing the "Submit" Button below, I agree to terms and conditions outlined below:

Note: if you do not wish to send this form over the internet, please fax it to us at 613-267-6371.

TERMS

I certify that the information I have given on this form is correct. I am applying for a loan from the Seller to Purchase a chattel as described in the attached bill of sale The Seller will be referring this application to a Financial Institution because the Seller intends to assign this loan to the Financial Institution, if my loan is approved. This loan is a separate transaction from the purchase; my obligation to make loan payments will not be affected by any dispute that may arise between me and the Seller.

THE SELLER AND THE FINANCIAL INSTITUTION MAY FROM TIME TO TIME GIVE ANY CREDIT AND OTHER INFORMATION ABOUT ME, INCLUDING ANY INFORMATION ON THIS FORM. TO. OR RECEIVED SUCH INFORMATION FROM: (A) ANY CREDIT BUREAU OR REPORTING AGENCY; (B) ANY PERSON WITH WHOM I HAVE OR PROPOSE TO HAVE FINANCIAL DEALINGS; AND (C) ANY PERSON IN CONNECTION WITH ANY DEALINGS I HAVE OR PROPOSE TO HAVE WITH THE DEALER OR FINANCIAL INSTITUTION. I agree that the Financial Institution may use that information to establish and maintain my relationship with it and to offer me any services as permitted by law.

If there is a "Buyer" and "co-Buyer", all references on this document to "I", "me" and "my" apply to both.