Application Statement



Applicant

Rose City Ford will contact you if we require a Joint Applicant to fill out a separate form.
Fields marked with * are mandatory.

Personal Information

Last Name * First Name * Middle Initial
 
Number of Dependants * Date of Birth *
/ /

Present Address

Number and Street * City * Province * Postal Code * Lived There *
Yrs Mos
Phone in Applicant's Home? * Area Code and Phone Number *

Home Ownership Status *

Government Issued ID

Driver's License Number and Province *

Email

Email Address at Home * Email Address at Work

Home Finances

Name of Landlord or Mortgage Holder * Address of Landlord or Mortgage Holder * Rent or Mortgage Payment *
$

Previous Address (if less than 2 years at present address)

Street City Province Postal Code

Level of Education (if under Age 27)

  High School Graduate?

Employment

Current Employer

Employer Name * City Province
Applicant's Occupation * Work Phone Number * Gross Salary *
$
Time on Job * Source of Other Income * Other Income *
Yrs   Mos $
Alimony, child support or separate maintenance income need not be revealed if you do not wish to have it considered as a basis for repaying this obligation.

Previous Employer (if less than 5 years at the current employer)

Employer's Name City Province Time on Previous Job
Yrs

* I certify that the above information is true and correct to the best of my knowledge and belief, that I have attained the age of majority, and that I have read the terms on the reverse side forming part of this Application, and understand that they permit the collection, use and disclosure of my personal information for the purposes specified.