Applicant
ApplicantCo-Applicant
Relation:
Title Mr.Ms.
First Name*
Middle Name
Last Name*
Sales Rep.
Vehicle you are interested in
Applying for
LeaseFinance
Deposit Amount
Marital Status
Common LawSeparatedMarriedSingleDivorcedWidow/Widower
Date of Birth*
Gender
MaleFemale
Driver's Licence
Licence Expiry
S.I.N.
E-mail Address*
Cell Phone*
Home Phone
Work Phone
Address*
Suite / Lot
City/Town
Prov.
Postal Code
At address for:
Home Status
Owner/MortgageRentOtherOwn Free & ClearWith Parents
Market Value
Mortgage Balance
Mortgage Holder/Landlord
Your Monthly Payment
Status Full TimePart TimeSelf-EmployedRetiredSeasonal WinterSeasonal Summer
Employer
Occupation/Title
Address
Employed for:
Gross Income
Per (check one)
YearMonthWeek
Have you ever been bankrupt?
NoYes Other Income
YearMonthWeek Phone Number
Annual Total
Other Income Description
PLEASE READ AND SIGN BELOW
In this agreement, “I”, “we”, “our”, “my”, “us” means the applicant and or the co-applicant that is applying for the service offered by Grande National Leasing. I/We hereby certify that the information given above is true, accurate and complete as at the statement date. I/We fully understand that such information shall be used to determine my/our credit worthiness. I/We understand that ALL INFORMATION WILL BE VERIFIED and any information that proves inaccurate will result in the application being terminated. I/We also authorize Grande National Leasing to disclose from time to time to other lenders, credit bureau or other credit reporting agencies any personal credit information about me/us. I/We understand that Grande National Leasing will charge a finance fee of $499.00 upon obtaining a loan/lease approval on my/our behalf. Grande National Leasing reserves the right to increase the lease/finance fee for applicants of above average complexity credit situations. The lease/finance fee, plus all applicable taxes, is non refundable and is due upon approval. The lease/finance fee may be added to the loan amount and I/We hereby (and by signing below) authorize and direct the lender to pay Grande National Leasing the above-mentioned lease/finance fee from the loan proceeds. This shall be good, sufficient and irrevocable authority for doing so.
SIGNATURE*
DATE
