519 453-1096
1473 Dundas St. London, ON N5W 3B8
[email protected]
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PERSONAL INFO
ADDRESS
HOUSING
EMPLOYMENT
INCOME
REVIEW
APPROVAL
1
personal information
Salutation
Mr.
Mrs.
Ms.
Dr.
First Name
*
Middle Name
Last Name
*
SIN
Date of Birth
*
Gender
Male
Female
Other
Marital Status
Single
Married
Divorced
Widowed
Email Address
*
Language of Correspondence
English
French
Phone Number
*
Mobile Number
*
2
CURRENT ADDRESS
Address Type
Rent
Own
Live With Family
Suite Number
Address Number
Street Name
Street Type
Direction
N
S
E
W
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Northwest Territories
Nunavut
Yukon
Postal Code
Years at Current Address
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3
HOME/MORTGAGE DETAILS
Address Type
Rent
Own
Live With Family
Market Value
Mortgage / Rent Amount
Mortgage Holder
Mortgage Payment
4
EMPLOYMENT INFORMATION
Occupation
Industry Type
Employer Name
Employment Status
Full-Time
Part-Time
Contract
Self-Employed
Employer Telephone
Ext
Employer Address
Address Type
Street
Rural Route
Postal Box
Suite Number
Address Number
Street Name
Street Type
Direction
N
S
E
W
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Northwest Territories
Nunavut
Yukon
Postal Code
Length of Employment
Years
0
1
2
3
4
5
6
7
8
9
10
11
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13
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20+
Months
0
1
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10
11
Employed Outside Canada
Out of Canada Employment Address
5
INCOME INFORMATION
Gross Income
Income Frequency
Monthly
Quarterly
Yearly
Proof of Income Type
Pay Stub
Bank Statement
Tax Return
Annual Employment Gross
6
CONSENT & SECURITY
I certify the information provided is accurate.
I authorize Highway Motors and its lending partners to verify information and perform a credit inquiry.
I consent to electronic communications.
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519 453-1096
Highway Motors
1473 Dundas St.
London, ON N5W 3B8
Why Apply With Us?
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Family Owned Since 1950
