testform First Name * Middle Name Last Name * Address City & Province Postal Code Are Your Over 19 Please select oneYesNo Is The Vehicle Free & Clear Of All Financial Obligations? Please select oneYesNo No: Why? Are You The Sole Owner Of The Vehicle? Please select oneYesNo No: name of other How Much Cash Do Your Require? How long do you require the loan for? 1 Year2 Year Insurance Registration No: Plate: VIN: Make: Model: Trim: Year: Color: Odometer: Transmission Please select oneAutoManual Do You Have A Spare Key: YesNo Any damage in excess of $2,000.00, or has a rebuilt Engine? Please select oneYesNo Yes: what? Is there collision insurance coverage on the vehicle? Please select oneYesNo How much is the collision deductible? Insurance Expiry Date: Driver’s License Number: BC / AB / ON: Expiry Date: Date of Birth: SIN: Eye Color: Home Phone: Email: Hair Color: Cell: Work Phone: Height: Employer: Marital Status: Weight: Job Title: Address: Spouse/Partner’s Name: Address if different from yours: Spouse/Partner Phone: Name: Phone: Name: Phone: Name: Phone: Name: Phone: Preferred Monthly Payment Method Please select oneAutomatic WithdrawalDirect Bank DepositEmail Transfer 2+3=?