creditform

VCI CREDIT APPLICATION

Please fill out the credit application below if you are approved a sales associate will contact you. If you have any questions please feel free to contact us at (403)255-6681, or e-mail tylerp@southcentrefinecars.com

Please Enter Your Email Address:

CONSUMER APPLICATION
CO-APPLICATION
BUSINESS APPLICATION

NB: WE WILL NOT APPROVE ANY CREDIT APPLICATION WHEN THE APPLICANT
DOES NOT HAVE A VALID PROVINCIAL DRIVERS LICENSE

PRESTIGE LEASE
PURCHASE

CURRENT CUSTOMER
YES NO

APPLICANT'S NAME:

SIN:

DATE OF BIRTH(mm\dd\yyyy):

CURRENT ADDRESS:

CITY:

PROVINCE:

POSTAL CODE:

HOW LONG:
years:
months:

PHONE NUMBER:

DRIVER'S LICENSE NO.:

EXPIRATION DATE(mm\dd\yyyy):

FILL IN THIS SECTION IF VEHICLE IS FOR DRIVER OTHER THAN APPLICANT

NAME IF VEHICLE IS FOR DRIVER OTHER THAN APPLICANT:

DATE OF BIRTH OF VEHICLE OWNER:

PHONE NUMBER OF VEHICLE OWNER:

CURRENT ADDRESS OF VEHICLE OWNER:

CITY OF VEHICLE OWNER:

PROVINCE OF VEHICLE OWNER:

POSTAL CODE OF VEHICLE OWNER:

HOW LONG:
years:
months:

RELATIONSHIP TO APPLICANT OF VEHICLE OWNER:

DRIVER'S LICENSE NO. OF VEHICLE OWNER:

EXPIRATION DATE(mm\dd\yyyy):

MARITAL STATUS
M   S   D   OTH

SPOUSE'S NAME:

SIN:

SPOUSE'S DATE OF BIRTH(dd\mm\yyyy):

OWN HOME   RENTING

OTHER:

NAME AND PHONE NO. OF LANDLORD OR MORTGAGE HOLDER:

RENT/MORTGAGE PAYMENT:

MARKET VALUE OF HOME:

MORTGAGE BALANCE:

PREVIOUS ADDRESS(if less than 2 years at present address)
STREET ADDRESS, CITY, PROVINCE,POSTAL CODE:

HOW LONG:
years:
months:

GARAGING LOCATION OF VEHICLE(if different from above)
STREET ADDRESS, CITY, PROVINCE,POSTAL CODE:

PRIMARY USE OF VEHICLE(S)
BUSINESS    PERSONAL

EMPLOYMENT INFORMATION:

SELF-EMPLOYED?
YES   NO

NAME OF CURRENT EMPLOYER:

DESCRIBE YOUR OCCUPATION:

BUSINESS PHONE NO.:

ADDRESS:

CITY:

PROVINCE:

POSTAL CODE:

GROSS MONTHLY INCOME:

HOW LONG:
years:    months:

NAME AND ADDRESS PREVIOUS EMPLOYER
(if less than 5 years at current employer):

HOW LONG:

DESCRIBE YOUR PREVIOUS OCCUPATION:

SPOUSE'S EMPLOYER NAME & ADDRESS:

SPOUSE'S OCCUPATION:

SPOUSE'S GROSS MONTHLY INCOME:

HOW LONG:
years:    months:

OTHER ASSETS(rrsp, bonds, shares($)):

SOURCES OF ADDITIONAL INCOME(describe):

ADDITIONAL MONTHLY INCOME:

OTHER OBLIGATIONS(alimony, child support, maintenance etc.):

TOTAL PER MONTH($):

PERSONAL REFERENCE & PHONE NUMBER:

NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING IN YOUR HOUSEHOLD:

PHONE NUMBER:

RELATIONSHIP:

CORPORATION PROPRIETORSHIP OTHER PARTNERSHIP GOVERNMENT

DATE OF INCORPORATION(mm/dd/yyyy):

FEDERAL CHARTER
PROVINCE OF

TYPE OF BUSINESS

APPLICANTS BUSINESS NAME:

A CURRENT AND YEAR END FINANCIAL STATEMENT IS REQUIRED FOR ALL CORPORATIONS, PARTNERSHIPS AND PROPRIETORSHIPS,ALLOTTED, IF POSSIBLE WITH COMPLETE P&L STATEMENT AND BALANCE SHEET.

BUSINESS ADDRESS:

CITY:

PROVINCE:

POSTAL CODE:

HOW LONG IN BUSINESS:
years:

OWNER'S NAME:

TITLE:

% OWNERSHIP:

HOW LONG IN BUSINESS:
years:

OWNER'S NAME:

TITLE:

% OWNERSHIP:

HOW LONG IN BUSINESS:
years:

CREDIT REFERENCES

include finance companies, banks, credit cards, charge accounts

NAME OF CREDITOR/CREDIT CARD/ SUPPLIER:	ACCOUNT NO.:	ACCOUNT:	BALANCE OWING($):	MONTHLY PAYMENTS($):
		OPEN CLOSED
		OPEN CLOSED
		OPEN CLOSED
		OPEN CLOSED

PREVIOUS CAR FINANCED BY:

CAR BALANCE OWING:

CAR MONTHLY PAYMENTS:

YOUR BANK'S NAME:

PHONE NUMBER:

TYPE OF ACCOUNT
SAVINGS CHEQUING CREDIT LINE

BANK'S ADDRESS/BRANCH TRANSIT NO./ACCOUNT NO.:

ACKNOWLEDGEMENT AND CONSENT

			 	
	We, the undersigned applicant(s) understand and agree that VW Credit Canada, Inc. ("VCI") may create a file of personal information about us in order to allow VCI to determine whether to enter into an agreement with us for the lease or installment sale of a motor vehicle.  We also understand and agree that if such an agreement is created, VCI may obtain further personal information about us as long as such agreement is outstanding.  We understand that such file about us will contain credit, medical, employment, vehicle insurance and/or other personal information.

	We understand and agree that VCI may use such personal information about us for the initial and ongoing credit assessment of us and for vehicle insurance tracking, internal administration  and marketing purposes (object of the file).  We agree that VCI may communicate such personal information to its affiliated companies and to third parties as may be necessary to obtain the information and process the information as required for the object of the file.

	Only authorized employees of VCI and its affiliated companies and agents, whose job functions involve assessment of credit worthiness, credit applications, monitoring, vehicle insurance tracking, processing of payments, internal administration, marketing of vehicles, and other related matters will have access to our file.
		
	If we wish to see our file or make corrections to it, we understand that we may do so by writing to the Credit Manager at the VCI offices at 3333 Cote Vertu Blvd, Ste 500, St.Laurent, Quebec, H4R 2N1, and sending our request by mail.

	We warrant to VCI that neither a bankruptcy proceeding nor a proposal is now or about to be made with us.  We warrant to VCI that the information we have given to VCI in this application is true and correct.

	We agree that we have had the opportunity to read this consent and acknowledgement before signing it and that we have received a copy of it.

	The parties here by confirm that they have requested that the present document be drafted in the English language.  Les parties confirment par les presentes qu'elles ont demande que le present document soit redige dans la langue anglaise (Quebec).

DATE(dd\mm\yyyy):

I THE APPLICANT AGREE WITH THE ACKNOWLEGDEMENT AND CONSENT:
I THE CO-APPLICANT AGREE WITH THE ACKNOWLEGDEMENT AND CONSENT:

This site uses PGP encryption if you are concerned about the safety of this site please print out a copy of the credit application and fax it to South Centre Fine Cars at (403) 255-8684 ATTN: Tyler Polzen.