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Family Owned Since 1950

All credit Situations Welcome

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PERSONAL INFO

ADDRESS

HOUSING

EMPLOYMENT

INCOME

REVIEW

APPROVAL

1

personal information

Salutation

First Name *

Middle Name

Last Name *

SIN

Date of Birth *

Gender

Marital Status

Email Address *

Language of Correspondence

Phone Number *

Mobile Number *

2

CURRENT ADDRESS

Address Type

Suite Number

Address Number

Street Name

Street Type

Direction

City

Province

Postal Code

Years at Current Address

Months

3

HOME/MORTGAGE DETAILS

Address Type

Market Value

Mortgage / Rent Amount

Mortgage Holder

Mortgage Payment

4

EMPLOYMENT INFORMATION

Occupation

Industry Type

Employer Name

Employment Status

Employer Telephone

Ext

Employer Address

Address Type

Suite Number

Address Number

Street Name

Street Type

Direction

City

Province

Postal Code

Length of Employment

Years

Months

Employed Outside Canada

Out of Canada Employment Address

5

INCOME INFORMATION

Gross Income

Income Frequency

Proof of Income Type

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.

2012 Volkswagen Passat 3.6L V6 Highline

Need Help?

519 453-1096

Highway Motors

1473 Dundas St.
London, ON N5W 3B8

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Family Owned Since 1950