Online Credit Application: Southridge Chrysler

Credit application requests will be processed the next business day. Please provide information at your discretion.

APPLICANT INFORMATION
First Name, Middle Initial *
Last Name *
Date of Birth * / MM / DD YYYY
Social Insurance Number *
Planning to purchase a vehicle
ADDRESS
Street
City Town
Province
Postal Code
Years/Months at Current Address
PREVIOUS ADDRESS

Optional - only complete this section if less than 2 years at current address.
Previous: Street
Previous: City Town
Previous: Province
Previous: Postal Code
Years/Months at Previous Address
CONTACT INFORMATION
Daytime Phone * - (###) - ### ####
Evening Phone - (###) - ### ####
Cell Phone - (###) - ### ####
Email *
Have you been speaking to a salesperson here at Southridge Chrysler already?
If so, please type in his/her name
Applicant Employment Information
Present Employer *
Workplace Phone
Occupation
Gross Monthly Income (Pretax) $ *
How long with present employer? *
Sources of other income
Other Gross Monthly Income (Pretax) $
SPOUSAL INFORMATION

IMPORTANT: If you have a spouse the Spouse's Gross Monthly Income and Time spent with the present employer questions must be completed even if it is zero.
Spouse's First Name, Middle Initial
Spouse's Last Name
Spouse's Date of Birth / MM / DD YYYY
Spouse's Social Insurance Number
Spouse's Present Employer
Spouse's Workplace Phone
Spouse's Occupation
Spouse's Gross Monthly Income (Pretax) $

IMPORTANT: If you have a spouse this fields must be completed even if it is zero.
Spouse: How long with present employer?
HOMEOWNER INFORMATION
Original mortgage amount $
Mortgage balance amount $
Mortgage or rent payment amount $ *
Current value of home $
VEHICLE PREFERENCE
Type of vehicle you plan to purchase
Down payment amount on vehicle $ *
Trade-in year (e.g. 2009)
Trade-in model
Trade-in approximate value $
LEGAL INFORMATION

APPLICANT AUTHORIZATION:

I hearby authorize Southridge Chrysler to conduct a personal credit worthiness 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 Southridge Chrysler may apply, and each source is authorized to provide Southridge Chrysler with such information. In addition, I authorize Southridge Chrysler to disclose, in response to direct inquiries from any other lender or credit bureau, any information concerning my loan and account that Southridge Chrysler considers appropriate and I agree to indemnify Southridge Chrysler and save it harmless from any and all claims on damages or otherwise arising from any such disclosure made by Southridge Chrysler.

The applicant is advised that Southridge Chrysler 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 Southridge Chrysler/or its assignee may require at any time in the connection with such transaction and to the 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.

Online Credit Application: Southridge Chrysler

Online Credit Application: Southridge Chrysler

APPLICANT INFORMATION

ADDRESS

PREVIOUS ADDRESS

CONTACT INFORMATION

Have you been speaking to a salesperson here at Southridge Chrysler already?

Applicant Employment Information

SPOUSAL INFORMATION

HOMEOWNER INFORMATION

VEHICLE PREFERENCE

LEGAL INFORMATION