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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
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.