Pacific Mazda

Credit Application

Please complete the form below with the most information as possible. Please also complete the Co-applicant Information section if you wish to present your spouse or other co-applicant in your credit request. Incomplete credit requests will be ignored.

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Applicant Information
 

Contact Information
*Fields marked with an asterisk are mandatory
       
First Name: *  
Last Name: *  
Social Insurance Number: *  
Driver's License Number:    
Date of Birth:    
Telephone:
(fill at least one) 		* Day: (format: 123-123-1234)
Night:
Email: *  
___________________________________________________________________________

Personal Information
*Fields marked with an asterisk are mandatory
Marital Status*    
Number of Dependants:    
Gross Monthly Income:   / month
Do you pay alimony?   If yes Amount: /month
Have you ever declared bankruptcy?   If yes Are you now free?
      Freed on: (dd/mm/yyyy)
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Current Address
*Fields marked with an asterisk are mandatory
Address: *  
City: *  
Province: *  
Postal Code: *  
Rent or Own?    
Residence Type *  
How long have you been living there? * (number of years)
If you are an Owner... If you are Renting...
Amount of Mortgage: Monthly Rent:
($) ($/month)
Mortgage Payment: Owner's Name:
($/month)
Market Value of your Property: Owner's Phone Number:
($)
___________________________________________________________________________

Previous Address
Please complete this section if you have lived at your current address for less than one (1) year.
Address:    
City:    
Province:    
Postal Code:    
Rent or Own?    
Residence Type:    
Monthly Rent or
Mortgage Payment:		   ($/month)
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Current Occupation
Occupation:    
Profession:    
Job Type:    
Employer's Name:  
Employer's City:   Province:
Employer's Phone Number:  
Gross Monthly Income:   ($/month)
Job Duration:   (number of years)
___________________________________________________________________________

Previous Occupation
Please complete this section if you have been at your current occupation for under two (2) years.
       
Occupation:    
Profession:    
Job Type:    
Employer's Name:  
Employer's City:   Province:
Employer's Phone Number:  
Gross Monthly Income:   ($/month)
Job Duration:   (number of years)
___________________________________________________________________________

Vehicle Information
*All fields are mandatory
Make: *  

Mazda
Model: *  
Trim: *   (ie. GT/GS etc.)
Year: *  
Transimission: *  
Exterior Colour: *  
Maximum Monthly Payment:     ($/month)   Taxes included?
Available Down Payment:     Taxes included?
___________________________________________________________________________

Co-Applicant Information
 

Co-Applicant Contact Information
*Fields marked with an asterisk are mandatory
       
First Name: *  
Last Name: *  
Social Insurance Number: *  
Driver's License Number:    
Date of Birth:    
Telephone:
(fill at least one) 		* Day: (format: 123-123-1234)
Night:
Email: *  
___________________________________________________________________________

Co-Applicant Personal Information
*Fields marked with an asterisk are mandatory
Marital Status:    
Number of Dependants:    
Gross Monthly Income:   / month
Do you pay alimony?   If yes Amount: /month
Have you ever declared bankruptcy?   If yes Are you now free?
      Freed on: (dd/mm/yyyy)
___________________________________________________________________________

Co-Applicant's Current Address
Same address as applicant.
Address: *  
City: *  
Province: *  
Postal Code: *  
Rent or Own?    
Residence Type *  
How long have you been living there? * (number of years)
If you are an Owner... If you are Renting...
Amount of Mortgage: Monthly Rent:
($) ($/month)
Mortgage Payment: Owner's Name:
($/month)
Market Value of your Property: Owner's Phone Number:
($)
___________________________________________________________________________

Co-Applicant'S Previous Address
Please complete this section if you have lived at your current address for less than one (1) year.
Same address as applicant.
Address:    
City:    
Province:    
Postal Code:    
Rent or Own?    
Residence Type:    
Monthly Rent or
Mortgage Payment:		   ($/month)
___________________________________________________________________________

CO-Applicant's Current Occupation
Occupation:    
Profession:    
Job Type:    
Employer's Name:  
Employer's City:   Province:
Employer's Phone Number:  
Gross Monthly Income:   ($/month)
Job Duration:   (number of years)
___________________________________________________________________________

Previous Occupation
Please complete this section if you have been at your current occupation for under two (2) years.
       
Occupation:    
Profession:    
Job Type:    
Employer's Name:  
Employer's City:   Province:
Employer's Phone Number:  
Gross Monthly Income:   ($/month)
Job Duration:   (number of years)
     

Questions/Comments
Please use the space below for any questions, comments or other relevant information.