FMack Application (PDF)

Fmack Auto Sales

Application For Loan
Salesperson:

Account Number:
Personal Information
Applicant

Co-Applicant (or Spouse)

Last Name:
First & Middle
Names:
Birth Date:

Title
Year (yyyy)

Month(mm):

Title
Day (dd):

Year (yyyy)

Month(mm):

Day (dd):

SIN
Marital Status
# of Dependents
Home Phone
Other Phone

Cell

Business

Cell

Business

Province

Postal Code

E-mail
Home Address
City
Residence Type

How Long?

Yrs.

Mths.

Previous Address

How Long?

Yrs.

Mths.

Identification
Have you ever
been:
Are you now or
do you anticipate
being involved in
litigation?

Type of ID

Type of ID

ID #

ID #

Place of Issue

Place of Issue

Bankrupt?

Yes

No Bankrupt?

Yes

No

Orderly Payment?

Yes

No Orderly Payment?

Yes

No

Yes

No

Yes

No

Details of Vehicle Purchase
Make

Model

Year

Total Selling Price
Trade in Allowance
Lien on Trade in
Net Trade in (A)
Cash Down Payment (B)
Total Down Payment (A + B)
Net Selling Price
Other Fees (Insurance, etc.)
Taxes
Total Financed
Rate Requested

Amortization Requested
Employment and Income
Applicant

Co-Applicant (or Spouse)

Present Employer
Address
Occupation
Employment
Status
Previous Employer
How Long
Gross Income
Other Income
Total Income
(Both Applicants)
Yes

Will this loan be used on behalf of a third party?

No

If “Yes”, please complete & attach a “Third Party Determination” form.
Financial Information
Housing

Monthly Payment

Description

Mortgage Payment

Vehicle

Or Rent

Vehicle
Investment
Other

Present Value

Consent and Authorization of Applicant(s)
In connection with this application for a loan, I hereby consent to and authorize FMack Auto to:
a) Verify, confirm, collect use and/or disclose any information contained in this loan application
for the purpose of making such inquiries and decisions in connection with this application.
b) Request, collect and obtain from any person; credit reporting agency; insurer; financial
institution; or any other entity as may be required, any information for the following purposes:
• To understand my needs;
• To elevate my credit standing and to share or exchange reports and information with credit
reporting agencies and/or other financial institutions;
• To determine my suitability and eligibility for products and services;
• To meet legal and regulatory requirements;
• To investigate and adjudicate insurance claims.
If I choose to provide my Social Insurance Number, I authorize it to be used for verifying and
reporting credit information to credit bureaus and credit reporting agencies. I understand that I may
refuse to consent to its use or disclosure for those purposes.
I hereby certify that the information in this credit application is true and complete and submitted for
the purpose of obtaining credit.

Signature of Witness

Date

Name of Witness (Please Print)

Signature of Witness

Name of Witness (Please Print)

Signature of Applicant (By typing your
name you agree to the terms of this
agreement.)

Name of Applicant (Please Print)

Date

Signature of Applicant (By typing your
name you agree to the terms of this
agreement.)

Name of Applicant (Please Print)
Account #