Leon Cheliadin

Direct Line: (604) 715-0377      Phone: (604) 273-8018


* Title
  * First Name
* Last Name
* Date of Birth
 *SIN - -
* E-mail Address
      
* Home Phone
 ( ) - -
Cell Phone
 ( ) - -
* Address
* City
Address
* Province
* Postal Code 
City
 * Address Duration
  Years     Months
Province
Postal Code 
* Rent/ Mortgage Payment
   * Rent:   Own:
Address Duration
  Years     Months
       
 

* Employer

  

 
Employer 
Occupation 
Work Duration 
  Years     Months
* Occupation
Work Phone
( ) - -     Ext 
 * Work Duration
  Years     Months
* Gross Monthly Income
Source of Other Income
  $
   
 

* Have you ever declared bankruptcy? No Yes
* Is a cosigner available if needed? No Yes
* I authorize you to run my credit report: No Yes
APPLICANT AUTHORIZATION: I authorize the Bank to conduct a personal investigation and BY MY SUBMITTING THIS FORM ACCEPT AS NOTICE IN WRITING OF AND AUTHORIZE THE OBTAINING OF ANY INFORMATION REQUIRED RELATED TO THIS APPLICATION from any source to whom the Bank may apply, and each source is authorized to provide the Bank with such information. In addition, I authorize the Bank to disclose, in response to direct inquiries from any other lender or credit bureau, any information concerning my loan and account that the Bank considers appropriate and I agree to indemnify the Bank and save it harmless from any and all claims on damages or otherwise arising from any such disclosure made by the Bank.

The applicant is advised that the Dealership or it's assignee intends to refer to a report from a credit reporting agency in connection with the sale transaction proposed; and the applicant consents to the obtaining of such information from his present and any future employer, any credit reporting agency or any other person the Dealership/or its assignee may require at any time in the connection with such transaction and to t he disclosure of any information concerning the undersigned to any credit reporting agency or any person with whom the applicant has or proposes to have financial relations.

Note: Credit requests will be processed next business day.
Please provide information at your discretion.

 

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