MIDLAND AUTO  Credit Application
Dealership Name:
Applicant Information
Title First Name   Initial Last Name   S.I.N.  




Address   City   Province Postal Code   Time at Address
Years Months
Birth Date   Home Phone  
(xxx-xxx-xxxx)		 Marital Status Other Photo ID # Email
Employment Information
Name Address City Province
Employment Duration Occupation/Job Title
Years Months
Work Phone (xxx-xxx-xxxx) Income per month (before taxes and other deductions)
  $
 
Landlord/Mortgage Holder Information (If Band Housing Select Band from Housing Type)
Land Type Rent/Mortgage Payment Landlord/Mortgage Holder Name Landlord Address Landlord Phone
$ /Month
If you are a Homeowner
Mortgage When Opened Mortgage Currently Owing Market Value of Home
$ $ $
Previous Address ( if current address is less than 2 years)
Address City Province Duration at Address
Years Months
Additional Comments:

Acknowledgment and Consent

By signing below, you affirm that the information you have given in this Application is true and complete and that you have not withheld any information. We will rely on the information you have given us to decide on your Application. You authorize us to give to, obtain, verify, share and exchange credit and other information about you and with others, including credit bureaus, and other persons with whom you may have financial dealings as well as any other person as may be permitted or required by law. you also expressly waive your right, where permitted by law, to receive a copy of any Financial Statements or Financing Change Statements registered under the Personal Property Security Act as a result of a loan made by us to you or any renewal or discharge thereof.
 
 
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