print
Dealer
* denotes required fields
DEALERSHIP *
SALESPERSON NAME
WHO ARE YOU
Buyer
* denotes required fields
Please enter all information below EXACTLY as it is on your primary identification (driver's license, etc).
DRIVER'S LICENSE #
DRIVER'S LICENSE EXPIRY
LEGAL FIRST NAME *
MIDDLE NAME
LEGAL LAST NAME *
BUYER'S EMAIL
GENDER
MARITAL STATUS
DATE OF BIRTH *
SOCIAL INSURANCE #
HOME PHONE*
CELL PHONE
WORK PHONE*
CURRENT ADDRESS
MAILING ADDRESS*
The address where your mail is delivered
PHYSICAL ADDRESS
Location of residence (ex: 1234 Smith Rd, NE 14 163 W4)
CITY*
PROVINCE / TERRITORY *

POSTAL CODE *
HOW LONG AT THIS ADDRESS?* Years, Months
EMPLOYER*
STREET ADDRESS
CITY*
PROVINCE / TERRITORY*
POSTAL CODE
POSITION / DEPARTMENT*
GROSS MONTHLY INCOME*
HOW LONG AT THIS EMPLOYER?* Years, Months

Second Buyer
* denotes required fields
Click here to add a co-applicant
Please enter all information below EXACTLY as it is on your primary identification (driver's license, etc).
DRIVER'S LICENSE #
DRIVER'S LICENSE EXPIRY
LEGAL FIRST NAME*
MIDDLE NAME
LEGAL LAST NAME*
BUYER'S EMAIL
GENDER
MARITAL STATUS
DATE OF BIRTH*
SOCIAL INSURANCE #
HOME PHONE*
CELL PHONE
WORK PHONE*
Check here if address is same as ABOVE
CURRENT ADDRESS
MAILING ADDRESS*
The address where your mail is delivered
PHYSICAL ADDRESS
Location of residence (ex: 1234 Smith Rd, NE 14 163 W4)
CITY*
PROVINCE / TERRITORY*
POSTAL CODE*
HOW LONG AT THIS ADDRESS?* Years, Months
EMPLOYER*
STREET ADDRESS
CITY *
PROVINCE / TERRITORY *
POSTAL CODE
POSITION / DEPARTMENT*
GROSS MONTHLY INCOME*
HOW LONG AT THIS EMPLOYER?* Years, Months

Asset & Liability Information
*denotes required fields
RESIDENTIAL STATUS*
MARKET VALUE OF PROPERTY
MORTGAGE BALANCE
RENT / MORTGAGE * PER MONTH
MORTGAGE HOLDER
(Name of Bank)

Product
YEAR *
MAKE*
MODEL*
PRODUCT TYPE*
Click here to add a second Product
YEAR *
MAKE*
MODEL*
PRODUCT TYPE *
MSRP
PRE-TAX PRICE * TAXABLE
FACTORY REBATE
DEALER DOCUMENTATION FEE
OPTIONS
FREIGHT/PDI
TIRE LEVY
BATTERY LEVY
APPROX DOWN PAYMENT
DELIVERY DATE
FACTORY WARRANTY IN MONTHS
WAS A FINANCE PROMOTION DISCUSSED
COMMENTS
Trade-In
YEAR
MAKE
MODEL
PRODUCT TYPE
TRADE-IN VALUE
LIEN HOLDER
LIEN AMOUNT OWING
Other Information
Application Agreement
I understand that I am applying for a loan from the Seller (the “Loan”) to purchase a chattel as described in the Seller’s bill of sale. On behalf of the Seller, LMG Finance Inc. will be referring this application to a financial institutions because the Seller intends to assign the Loan to the financial institution (the “Lender”) if my application is approved. The Loan is a separate transaction from the purchase; my obligation to make Loan payments to the Lender will not be affected by any dispute that may arise between me and the Seller. I hereby certify that the information I have given on this form is true and correct.

To enable financial institutions to assess the risk of providing credit to me, I consent to LMG Finance Inc., and its affiliates and subsidiaries (collectively, “LMG”), and the financial institutions obtaining my full personal credit report from credit reporting agencies and providing information about my credit history and other personal information to other financial institutions and credit reporting agencies to update my credit information and maintain the integrity of the credit reporting system.

I consent to LMG, the Seller and the Lender to collect, use and disclose my personal information, as set out in the LMG Credit Application form, for the purposes of:
  1. verifying my identity, employment, residence, credit and other personal information about me in accordance with the Lender’s requirements to manage its risk arising from its operations or as otherwise required by law, including money laundering laws and regulations;
  2. enabling the Lender to adequately assess, from time to time, the risks associated with opening and operating the Loan, including any future loans, any present or future credit applications, providing financial products or services requested by me, or the continued provision of credit or financial products or service to me;
  3. enforcing the Loan and any related agreement and to facilitate the collection of debts owing by me or for which I am financially responsible to the Lender;
  4. processing this application and providing and administering the Loan and related products and services for me, and ensuring my records are kept separate from others with the same name; and
  5. transferring, financing, or selling of loans held by the Lender, such as in a syndication or securitisation of loans.

I can withdraw any consent I give for the collection, use and disclosure of my personal information at any time by contacting LMG and the Lender in writing. If I withdraw my consent, I understand LMG and the Lender may no longer be able to provide me with the Loan.

I also consent to LMG and its affiliates and subsidiaries communicating with me by commercial electronic message (such a email, voice, sound, text or image) for any purpose related to the uses listed above in this consent form, the Loan and any future loan and insurance opportunities. My consent is not required where LMG communicate with me by commercial electronic message for the purpose of, and in keeping with, legislative requirements. I may withdraw my consent to receiving commercial electronic messages at any time by contacting LMG.

I understand LMG and the Lender will use my personal information relating to the Loan to market to me, including by commercial electronic message, if I have previously provided a marketing consent to the Lender.

Additional information about LMG’s privacy policy can be obtained here: https://www.lmgfinance.ca/privacy-policy

I understand that this acknowledgement constitutes my electronic signature, acceptance, and agreement of the above conditions. I understand that my electronic signature, whether digital or encrypted, is intended to authenticate this writing and to have the same force and effect as a manual signature.
APPLICANT SIGNATURE
By checking this box, you acknowledge the above agreement.