All shaded fields are required.
Personal Information
Salutation
Dr.
Miss
Mr.
Mrs.
Ms.
Gender
Male
Female
Marital Status
Common Law
Divorced
Married
Separated
Single
Widow/Widower
Date Of Birth
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
Current Address
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
How long have you been living here?
Mth(s)
0
1
2
3
4
5
6
7
8
9
10
11
Previous Address
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
How long did you live there?
Mth(s)
0
1
2
3
4
5
6
7
8
9
10
11
Current Employment
Type
At home
Executive
Labourer
Management
Office Staff
Other
Production
Professional
Retired
Sales
Self-Employed
Service
Student
Trades
Unemployed
Status
Full Time
Full Time (Probation)
Part Time (Casual)
Part Time (Regular)
Retired
Seasonal Summer
Seasonal Winter
Self Employed
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
How long have you been working here?
Mth(s)
0
1
2
3
4
5
6
7
8
9
10
11
Previous Employment
Type
At home
Executive
Labourer
Management
Office Staff
Other
Production
Professional
Retired
Sales
Self-Employed
Service
Student
Trades
Unemployed
Status
Full Time
Full Time (Probation)
Part Time (Casual)
Part Time (Regular)
Retired
Seasonal Summer
Seasonal Winter
Self Employed
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
How long did you work there?
Mth(s)
0
1
2
3
4
5
6
7
8
9
10
11
Home / Mortgage Information
Home Status
Other
Own Free & Clear
Own Mobile Home
Own with Mortgage
Rent
Reserve Housing
With Parents
Income Details
Yearly
Monthly
Semi-Monthly
Bi-Weekly
Weekly
Yearly
Monthly
Semi-Monthly
Bi-Weekly
Weekly
Other Information
Previous Bankruptcy?
Yes
No
Previous Repossession?
Yes
No
Is Cosigner Available?
Yes
No
How did you hear about us?
AutoTrader
Driving By
Direct Mail
Previous Customer
Referral/Friend
Web Search
Other
Google
Yahoo
MSN
Other
For your security please enter the security code below.
I agree to receive email notifications and offers from Mississauga Auto Centre. I understand I can withdraw my consent at any time.
Disclaimer:
By submitting this application, you authorize us to run your credit report.