Credit Application


Tell us about yourself...

First Name:
Initial:
Last Name:

Birthdate: (month/day/year)
   

SIN:
Email:
Home/Main Phone:
Cell Phone:

Tell us about where you live...

Address:

City:
Province:
Postal Code:

How long at this address:
yrs
If less than 2 years
please enter previous address below 		Rent or Own?:
Rent per month:

Landlord or Mortgage Holder Name and Phone Number:



Previous Address:

City:
Province:
Postal Code:

How long at this address:
yrs 		Rent or Own?:
Rent per month:


Tell us about where you work...

Occupation:
Monthly Income:

Employer:
Work Phone:

Location:
How Long:
yrs
If less than 2 years please
enter previous employer belo/span>


Previous Employer:
How Long:


The vehicle I want is...(leave blank if you don't know)

Make:
 Model:
Stock#:

Additional Vehicle Information:


Tell us your finance preferences...

Do you presently:
Own a vehicle  Lease a vehicle  Existing auto loan  Do not own a vehicle

Do you have a trade-in vehicle:

Do you have a down payment:

Contact me by:
Email  Cell Phone  Home/Main Phone  Work Phone

Additional Comments:

How did you find us:
Newspaper  Radio/TV  Referral  Other


Nanaimo Motor Products Ltd.

250-755-4040

211 Poplar Street. Nanaimo, BC. V9S-2G8

sales@nanaimomotorproducts.com Fax: 250-591-6060

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