|
 |
|
Dealer |
* denotes required fields |
|
|
DEALERSHIP NAME * |
|
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 |
|
|
|
PROMOTION DETAILS |
|
|
|
| |
|
| |
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 to purchase a chattel as described in the Seller’s bill of sale. On behalf of the Seller, LMG Finance Inc. ("LMG") will be referring this application to a Financial Institution because the Seller intends to assign this loan to the Financial Institution, if my loan is approved. This loan is a separate transaction from the purchase; my obligation to make loan payments 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.
I grant LMG and the Financial Institution permission to obtain a credit report on me for all legitimate purposes in connection with this transaction. I acknowledge that LMG and the Financial Institution may from time to time give any credit and other information about me to, or received such information from: (a) any credit bureau or reporting agency; (b) any person with whom I have or purpose to have financial dealings; and (c) any person in connection with any dealings I have or propose to have with LMG, the Seller, or the Financial Institution.
I agree that LMG, the Seller and the Financial Institution may use the information to establish and maintain my relationship with it and to offer me any services as permitted by law. I also hereby give LMG and all LMG affiliates and subsidiaries express consent to communicate with me regarding existing transactions and or future loan and insurance opportunities. This consent for communication extends to all communication methods including electronic delivery of messages, including email and SMS.
I consent and agree that my clicking of the “Submit” button constitutes my electronic signature, acceptance, and agreement of the above conditions.
|
APPLICANT SIGNATURE |
| |
|
By checking this box, you acknowledge that this is in fact your electronic signature. |
|
|
|
|