Tell Us About Yourself Mr Miss Mrs Ms	Applicant Co-signer for	*E-mail
*Last Name	*First Name
Middle Initial	Home Address
City/Town	Province
Postal Code	*Home Phone #	Cellular Phone #
SIN #	Birthdate (MM/DD/YY) - -	# Of Dependents
Are You: Married Divorced Partnered Single	Do You: Own Your Home Rent L/w Parents Other	How Long Have You Lived There? Years Months
How Much Is Your Mortgage/Rent?	Landlord or Mortgage Holder	Phone #
Spouse/Partner's Last Name	First Name	Middle Initial
SIN #	Birthdate (MM/DD/YY) - -

Tell Us About Your Employment and Income
Current Employer -	Position/Occupation	Part-Time Permanent Contract Seasonal
Address	Gross Monthly Income
Contact Name To Confirm Employment -	Applicants Previous Employer (if less than 36 months) -
Other Income Source? (Part-Time Job, Home Business, Pensions, Allowances)	Gross Monthly Income
Spouse's Current Employer -	Position/Occupation	Part-Time Permanent Contract Seasonal
Address	Gross Monthly Income
Contact Name To Confirm Employment -

Tell Us About Your Banking & Credit Information
Have you ever declared bankruptcy in the past 7 years? Yes No	Have you ever had a vehicle repossessed? Yes No	Are you required to pay alimony or child support? Yes No	Do you have established credit at this time? Yes No	Are any of your debts now past due? Yes No
Current Debt & Other Obligations	Account Number	Balance	Monthly Payment	# of Payments Left?
Current Debt & Other Obligations	Account Number	Balance	Monthly Payment	# of Payments Left?
Current Debt & Other Obligations	Account Number	Balance	Monthly Payment	# of Payments Left?
Your Bank's Name		Bank Address
Town/City		Province

Family & Personal References (Known More Than One Year) With Address and Telephone Number
Name Of Nearest Relative Relationship	Address City/Town Phone #
Personal Reference (1) Relationship	Address City/Town Phone #
Personal Reference (2) Relationship	Address City/Town Phone #
Personal Reference (3) Relationship	Address City/Town Phone #

Everything stated in this application is true to the best of my knowledge. I understand that Zimmer Wheaton Pontiac Buick GMC (Kamloops) Ltd. will retain this application whether or not it is approved. By submitting below I accept as notice in writing of and consent to Zimmer Wheaton Pontiac Buick GMC (Kamloops) Ltd., its assignees, or transferees, obtaining or exchanging any information about me at any time from any credit bureau, my employer, or any other person in connection with any relationship between us or those persons which you or I may wish to establish.